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'- may. .�..-. �[ea_,.-,..��..++ - '�{,�,.�:- ....�..•�� i�;4'" y y..: .^:k-'7*+tM'k:yr. .. .ck�.... r WP.4,Yi':Y ' --^-�o�r.rs':.� _ .-. <br /> IN___AlirONAL _ <br /> TECHNOLOGY ANALYSIS REU EST AND Reference Document No. , �'q 5 3 <br /> CORPORATION I909i�; CHAIN OF CUSTODY-RECORD* . Page 1 of <br /> Project Name/No• 1 _ FA: r_.T3c 't4r4r(oN <br /> Samples Sl�iPment Date l��K I� 135 Bill to:5 <br /> Sample Team Members 2 'iJ• ��IQLZO <br /> °Lab Destination''e S`T`AiS L <br /> �-�c+��ca t <br /> -, <br /> Proftt Center No. s ;i�.S LI I _T1 <br /> Lab ContactsCoe`� <br /> Project Manager4 T.' 4rt9*Ili r. ' r. Project Contact/Phone'12 <br /> Report i6:10 71 T Comer m <br /> Purchase Order No:s �---- ; Carrier%Vllaybill Na:;13 = ° = (ate <br /> Required R ---1 i _i Z �.. - <br /> n <br /> eport Date a - <br /> f • <br /> Sample 14 Sample 15 Date/Time,16 Container) Sample) Pre• 19 20 `� <br /> Number Requested Testing Condition on 21 Disposal 22 <br /> Descry n Collected T e ' Volume ssrvatiire P ram Recei Record Na. <br /> +z+�9 I >=� FIELD .E�AMW ; +zt���' 1018 1/0A`` 40"L : :FICO EX <br /> f. .,✓ o <br /> UH LIA <br /> Ll <br /> ` - - CL <br /> I I�'� I }-1k1 I Grzou�Gici YO <br /> A' µ <br /> RW UWE= En <br /> Q <br /> Special Instructions: 23 a <br /> Possible Hazard Identification: 24 <br /> Non-hazard. Flammable ❑ Sample Disposal: 25 a <br /> J Skin irritant Cly Poison 8 J Unknown Return to Client U11 Disposal by Lat,[2- ' Archive (mos ) 0 <br /> Turnaroum26 evel:27Normal L <br /> Rush�J <br /> Pro <br /> 'ect Specific (s eci p' 5 <br /> '1. Relinquished by--� , n"�] <br /> Date, t� 9I 1. Received by 2 Date: <br /> (Signature/Affiliation) r�-""'�Q/ fC - _ -f� <br /> Tlme: Id L1!a (Signature/Affiliation) n <br /> Time: JS-p o <br /> 2. Relinquished by Date: 2. Receiv <br /> [signature/Affiliation] y Date: N <br /> Time:. (Signature/ i tion] Time: <br /> Si Relinquished by Date: 3. Received by <br /> [Signature/Affiliation) Date: <br /> Time: . (Signature/Affiliation) Time: <br /> Comments:29 <br /> MCAMM1 <br />