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� <br /> TERNATIONAL ANALYSIS QUEST AND Reference Document Jo <br /> kIfTECHNOLOGY 3 3795 `. <br /> ORPORATION CHAIN OF CUSTODY RECORD* Page <br /> -�-afi- <br /> Iqogr(ffl 3 of 3 <br /> Project Name/No 'mac. Say Samples Shipment Date 7 UP 17-13 Bill to 5 =- Co1ZP <br /> Sample Team Members 2 Lab Destination 8 a- - `f-?As� -F;;ACNeC0 <br /> _ h A Qn►v iz, CA <br /> Profit Center No 3 `jl _ _ _ Lab Contact 9 W �c~��_ _ 9 3 <br /> Project Manager -:I? W-LAM <) -J-'%? Project Contact/Phone 12 <br /> Report to 10 Z.`T Co1ZP <br /> Purchase Order No 6 Carrier/Waybill No 13 _ CA:!> T-M"tau6S <br /> Required Report Date 11 i'Z-zi9-91 <br /> Sample 14 Sample 15 Dete/Ttme16 CantstnerSemple1 Pre 19 Requested Testing 20 Condition an 21 Otsposel 22 <br /> Number Dascnt on/T Collected T Volume 180rvatm rem Rece Record No <br /> G �-� vG r S <br /> �Z�Zq� �rw3 �muacww� 1?Ip�r /5I.5 VOA yOM� INCL <br /> Sri <br /> 1C-- 4-' .�„� V -r�r CD <br /> 5 <br /> :AZ 1, , <br /> 4 ij r <br /> Special Instructions 23 <br /> Possible Haza d Identification 24 Sample Disposal 25 <br /> Non-hazard Flammable J Skin Irritant J Polson S J Unknown 1J Return to Client J Disposal by Lab,-_J' Archive [mos ] <br /> Turnaround Time Required 26 DC Level 27 <br /> Normal/ Rush „J I 1--J II J III J Project Specific (specify) <br /> 1 Relinquished 28 Date 17- (3-q1 1 Received by Date <br /> (Signature/Affiliation] � ,L Time 10L4.5iISrgnature/Affiliation) Time <br /> 2 Relinquished by �_ Date is-<3 crl 2 Recery y ;Z�a towxij Date - <br /> (Srynature/AffiliatonI Time / (SrgnaWre/A ua <br /> Time <br /> 3 Relinquishe Date 3 Received by Date <br /> ISignature/Affiliation <br /> Time (Srgnewre/Affiliatron) Time <br /> Comments 29 <br />