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o�.ow I � 1"0J7HAMYL R ES%N� M %erfi a oCoccumen �3 � T <br /> I!J_TPORATION - -- F CU <br /> S Y RECORD Page 1 of Z <br /> Project Name/No I UL-042Samples Shipment Date 7_ -1 — - ' Y Bill to 5 :: ' <br /> Sample Team Members 2 �•�*�D�J Lab Destination eMICA►-��� <br /> Profit Center Na Lab Contact 9_ �p ��' �Flap <br /> Project 9 ect Mana er 4 S G-� � Project Contact/Phone 125.GCJSio�z - ° <br /> _ / �'� 3 <br /> s - - - Report to 10 _� ' ©rte=� V <br /> 13 <br /> Purchase Order No Carrier/Waybill No <br /> ca <br /> Required Report Date 11 - - - — - 3 <br /> j r . • <br /> sample 14 Sample 15 Date�mei6 Container samplel per. 19 20 -- - T <br /> Number Descn on/Type s Colleeted Type Volume servative Requested testing Condition on 21 _ Disposal 22 <br /> R ram Receipt i t <br /> V w I - S-U �r 36599 <br /> l _ <br /> " I m <br /> VV,/ ( - S. S 0112,5 `- `t/�7t tt r I� 36600 <br /> 1 a <br /> yy 1 R I n <br /> b FSC Z I <br /> i <br /> V vA11 azo T::IL=s I L r�c -�' 36601 1 <br /> vwz - Z. o <br /> k! <br /> 114 <br /> 1 i <br /> i low o <br /> 3s6 � <br /> f <br /> W.LZ--.T <br /> tr <br /> T c r <br /> 36603 <br /> Special Instructions 23 Et <br /> E <br /> Possible Hazard Identificattan 24 Sample Disposal 25 <br /> Non-hazard/f Flammable IJ Skin Irritant IJ Poison--13 i�J Unknown U Return to Client IJ Disposal by Lab.I" Archive _ T (mos , ro <br /> Turnarouo Time Required 26 DC vel 2z _ M <br /> Normal/... Rush'J <br /> IYJ� 11 IJ III Project S ecific (specify) <br /> a <br /> 1 Relinquished Date l� 9y 1 Received b 28 .�'�2_�,i <br /> 15rgnbulre/Affi6eGnn) - — Y / Date <br /> k&nnoL� Time �Z/� )SignaWre/A�6atronJ ��� <br /> 2 Relinquished by Date 2 Received b Timeyr- <br /> rs gneture/ArPl+eGnnJ -- - -- - - Y Date N <br /> Time (sgnature/Afiiawn) Time--- <br /> 3 Relinquished by Date _ _ 44f ved b <br /> 15+gnature/AHil+at+on, i T — #� ,gi JY Date <br /> e - <br /> Tim <br /> Comments 29 GOOD c01'offlol�,—, r� IFRp irto <br /> FIND SPACE A�EM' C0W1`,INCRS <br /> I <br /> ARCA ar1591 <br />