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TECMOLOOGNY� ) ANALYSIS RE EST AND ;�' �� Reference Document No 7954 <br /> CORPORATION , CHAIN OF CUSTODYiRECORD* Page , <br /> ti r- A ; ,J ,_ �� c [T , -1 .s s r fY . v <br /> Protect Name/No L� c� fi -_ c1c our Samples Shipment Datea7cctt U " �J? BI#I to 5 �r Ccsi <br /> j ilr�� ]= FKI IECG � <br /> Sample Team Members 2 :i�+� = d s , Lab Destination a�3�A� -j'' AJJ`iax - <br /> Profit Center No.-3 ,may t ' r Y �_ y 6 ..�y. ct"i� Q `T o w - — - ' 1 r�r� E c c►1 r�i <br /> ' rr r n v1 -Lab Contact 9 i wJ <br /> Protect Manager4 �+ ExK ,"7'2 `-' ;� Protect Contact/Phone 12 �=Io) 9100 ° r = �-- 3 <br /> , Report to 10 r 1 7 Co(z� m <br /> Purchase Order No{� _ '' t= 4 n Carrier/Waybill No,, `� ° ra env+` K <br /> Required Report Date 11 <br /> N <br /> Sample 14 t Semple 15 ) Date/Time16 Container mplel Pro. 19 Requested Testing 20 Condition on 21 Disposal 22 <br /> Number L Collected ' w Volume L servaNN+rs T c ram - Race Record No. <br /> 'F <br /> 12 i�:q I "ujl Urz,56 n, o rr-#c' 1717 it 13Z} r.PA ���L y �` J ( w - { <br /> CD <br /> `J o <br /> Cl U ) , r <br /> c? .7 1�' i� W <br /> a <br /> I� iza1 M wz L �, I vat �T�X : _) r r _ UH ts 21 <br /> t, la <br /> r } ' <br /> L I <br /> J JJ _ En <br /> L { , � , / " � , M <br /> U r e) <br /> Special Instructions.-23 <br /> Possible Hazard Identification 24 _' r - fSample Disposal 2s ,p 1 a <br /> Non-hazard.Qr Flammable Qj Skin Irritant (J r Poison B �J I Unkn'bwn fa4 Return to Client Lj1 ) Disposal by rLaba- Archive (mos ] <br /> Turnaround Time Required 26 L DCL vel 27 a 9 <br /> NormaLL2r Rush[J - T r II J - 1111:1 Proect Specific (s ecy ' 5 <br /> 1 Relinquished b 2e " Date (-< (� 1 Received by 2 Date -9' <br /> (Signature/AffihsGonl .fit T I Time (51gnawm/Affiliation) Time <br /> 2 Relinquished by Date 2 Receiv y Date <br /> Isagnauma/AMauon) - Time s: {signature/Affi iationi ; z (' , Time <br /> 3 Relinquished by Date 3 ,Received by r, Date <br /> (Signature/Affihetron) ' Time f (Signetura/Affibation) Time. <br /> 7 <br /> Comments 29 i <br /> rr <br /> 5 i) <br /> MCA 3115191 <br />