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-Ile �-�� r � rr ww....PT'] '9r ie✓•^rrylfv�� `lrr �+/ <br /> arq r.� r~ .7jn.w r,ry +_— S <br /> i �ATIONAL� _ ANALYSIS REEST AND r� Reference Docum ; <br /> COMRTECHNOLM CHAIN OF CUSTODY RECORD*" ( f ent o 7 <br /> 950 <br /> coRpoRAr�oN 3 I , �S r � � LPage 'I of <br /> � <br /> Project Name/No 1� . Seca- >rr�krb� Samples Shipment Date 7tr"Y 7` 4:; I�•1?•9� Bill to 5 .rte CLE' - W � <br /> Sample Team Members 2 :=;> A) ' 1 Lab Destination'8 FGL -Ciu�i�,�c <br /> 3 <br /> Profit Center No � /� r Lab Contact e'` W <br /> -= ° - <br /> Project Manager4_ kms/ `err: - Project Contact/Phone 712 kuEra .7, (54'�q/Cb- 10 <br /> Purchase Order Na s -rd16t�21 _ 13 n F, w Report to m <br /> -- ,..._.�. 4 e Carrier`/Waybill No.' `�vic f- F, c3 <br /> 11 '✓Z-Z9-qIA - - <br /> Required Report Date_ r "801M • j r <br /> 31 <br /> Sample 14 _ Sample 15 , atums 16, Containerl Sample i �,pry 19 Requested Testlne 20 _ Condrtion on 21 Dispel 22 <br /> Number' Deem' n Collected T _ Volume seruadMs ram , , - - R Record No. <br /> [71 <br /> rt�l J325s �oC t0 ' <br /> N <br /> i �, r, y T t � r 2 <br /> `a <br /> , <br /> r <br /> � <br /> , <br /> r r T - k :- 5• �' r'' • w C7 d 7 4 J+ «.. <br /> n qZ <br /> '_' - ,'' `, ' ce ' Q1 C) rn, t C? b C= O .Q 4 3 ✓ T rn •, W i7 „ <br /> t u �i 1 = o r L m m i o "n I n= •' i,r <br /> Ln <br /> 17 �, ' - ti r0 �1 ft+ �r \+ " ^� , I i r I f7 <br /> V LZ t <br /> C. <br /> Special Instructions - _ - s a F^ ' = - 1 <br /> X23 Pl �, m r cT r ry r_ Cr �, ;z °7 ` v L' `; 3 <br /> Possible Hazard Identification 24S <br /> ample_ T Sample Disposal 25� <br /> Non-hazards Flammable IJ; Skin IrrltaFtt C , Polson B Unknown ` '- ' <br /> QI F Return to Client Qj Disposal by Lab- =Archive (mos ) �' <br /> ro <br /> Turnaround Time Required 26 OC Level 27 w aLj <br /> Narmal,l� Rush _ - „ f� �_ �� c <br /> ' " ' C. IQ , II E � Ill � = Pro ect Specific (s eco )' In t r r, � <br /> 1 Relinquished by Date _ i z i z-Q �� 1 Received by 2 r „ _ Date Z 1 z 5 54 <br /> (S+gna /Affi4ation] — _ Time ^ 1(� I O t (Signature/Affiliation ' r`, " Time 1 <br /> 2 Relinquished by Date 2 Received by Date o M <br /> [Signature/Affillationi ° Time (9gnab—/Aff&avon) rr w Time. <br /> 3 Relinquished by Date 3 Received by Dater <br /> (agnature/Affilmon) <br /> _� Time {9gnature/Affi6ation) <br /> ,- Time,. <br /> Comments 29 r <br /> , > r <br /> c, <br /> MCA 11511 <br />