Laserfiche WebLink
i>0FIN 1 � �- � MW >� <br /> 7-1- 1,2 <br /> INTERNATIONAL ANALYSIS REQUEST AND Reference Document No 3 3 7 9 5 ? <br /> ncNNOLOGY CHAIN OF CUSTODY RECORD* Page 1 of <br /> CORPORATION 1 clo91(o <br /> Project Name/No -f L 5w-94010 Samples Shipment Date 7—ric��,CD L)P IZ'13 Bill to 5 Z` — colzp <br /> Sample Team Members 2 --r-> "�" _ Lab Destination 8 _ -L-�AS <br /> Profit Center No 3 35 Lab Contact 9 <br /> Project Manager 4 �? �*31LZ� � t2__ Project Contact/Phone �°):372-�11ao Report 10 TT Ca1� <br /> Purchase Order No 6 Carrier/Waybill No 13 t'- AMYJc) <br /> Required Report Date 11 I z -z$ -91 <br /> Sample 14 Sample 15 Date/Timei6 Contsiner1Sampls" Prs- 19 Requested Testing 20 Condition on 21 Disposal 22 <br /> Number Descry Collected T Volume eewratiysProgram Record No <br /> 14 1 z 1z9 I r-73 F,1 EID S.A#.H[ 0imi Iola VCA '�0 HL HCL <br /> F <br /> p <br /> u� ?r <br /> i2 iZ9 I G2ou 7AT /1325 1lCA qd"L- <br /> - <br /> �� rn�SSiab�r, <br /> Special Instructions 23 <br /> Possible Hazird Identification 24 Sample Disposal 25 <br /> Non-hazardFlammable J Skin Irritant J Polson B J Unknown J Return to Client J Disposal by Labe Archive (mos j <br /> Turnarour}d Time Required 26 aC t�evel 27 <br /> Normal✓A Rush J Ill J Project Specific (s ect ) <br /> 1 Relinquished 28 ©ate _ iZ-i3-`ll 1 Received by 2 Date <br /> ISagnuture/Atf l awn) Time I Q t4 S J&gneuire/AFfihadon) Time A,5--OL? <br /> 2 Relinquished by 2 Date /J-V 2 Receiv y �i-►�s �J Date /--w-�`91 <br /> ISignauie/Affrsaatu,nl �� Time (Sagnature/A don �r Time ,z,Q <br /> �Zz3 Relinquished Date 3 Received by Date <br /> I'xiltio ure/Aff lwivuii Time (Signature/Aff+t,adnn) Time <br /> Comments 29 <br />