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MR / T' / - �I � .■IS >. ll>. <br /> ATTONAL ANALYSIS R VEST AND Reference Document lro3 2 8 6 2 7 <br /> TECHNOLOGY <br /> CORPORATION CHAIN OF CUSTODY RECOR Page 1 of <br /> Pro ect Name/No 1 Gff-&&a��qles <br /> 5I Shipment Date �.Z �l 8111 to fi Sample Team Members2e4 n � Lab Destination e .� •vfdl� ry �/ <br /> 9 <br /> 3 <br /> Profit Center No S_ �,L _ _ Lab Contact <br /> Project Manager4 � d•, �/project Contact/Phone 12 , <br /> K�/ ,7 k-a I /✓ Report to10 <br /> Purchase Order Nos T <br /> 13 T 7 <br /> / 70 l/�a Carrier/Waybill No - � u <br /> Required Report Date 11IV <br /> 1A0 <br /> - <br /> T <br /> Sample 14 Sample 15 Date/Time Container)rSample) Pre. 19 Requested Testing 20 Condition on 21 Disposal 22 u <br /> Number Desch on/T Collected T me sarvatnre <br /> /� I Program R Record No <br /> t4 / G�1f '� • 1 q �' .� x,704 SrT1S Saa <br /> fq 1;4 iv — �l� a <br /> 4 <br /> w l,� �� D a r <br /> M w - 1 /a?7 <br /> L1JVV7 <br /> U <br /> n <br /> Q, <br /> G <br /> Special Instructions 23 <br /> Possible Haz rd Identification 24 Sample Disposal 25 <br /> Non-hazard Flammable J Skin Irritant J Poison 8 J Unknown J L Return to Client J Disposal by Lab Archie [mos ) <br /> I Turnar u d Time Re d 26 C eve) 27 a <br /> Normal Rush J I AJ III J Project S ecific [s eci ) <br /> 1 Relinquished bate / 1 Received by e Date 1.2 y-y/ <br /> [Sgnawre/AffdiauonJ Time / ignature/AffABUon) <br /> Time73 <br /> /5/2 <br /> o <br /> 2 Relinquished by Date i,2 -9-9/ 2 Receiv y J Date <br /> (5ignawre/Affdiauon) Time (Signawre/Q tion �ICGGr Time 1ZL2 <br /> 3 Rellnquishe y Date 3 Received by Date <br /> (Signature/Affdiauon) Time [Signature/AMmuon) Time <br /> Comments 29 <br />