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"Mm, <br /> A1W W W AMNAL~S SUM AM 00 0$eferreence�cum�>� M <br /> OLOGYATION/Iq0�1� • Cly CHAIN OF CU ODY RECORD* Page 1 of � <br /> Project Name/NoShipment Date 7 B)ll to 5 � <br /> 2 kVAJ Lab Destination 9 <br /> Sample Team Members �. �,4ti - <br /> Profit Center No 3 d/ Lab Contact 9 � '��� c��5�= - Z::> <br /> Project Manager �-G' Project Contact/Phone 12y.�,q„� �5�0 � '� fo <br /> Report to <br /> Purchase Order Nos Carrier/Waybill No 13 �l� _ _ _ <br /> Required Report Date 1 <br /> Sample 14 Sample 15 Date/Time 16 Contained Semple 1 Pre- 19 Requested Testing 20 Condition on 21 Disposal 22 <br /> Number Descn tion/T Collected Type volume Joe <br /> rvative R ram Receipt <br /> Record No <br /> VWr - q.5 j� ���r �e4s � <br /> VWA _ S <br /> t I : �4 <br /> Ili k L vIt I <br /> Special Instructions 23 <br /> Possible Hazes Identification 24 Sample Disposal 25 <br /> Non hazard /J Flammable J Skin Irritant J Poison B 1J Unknown J Return to Client J Disposal by Lab J Archive (mos J <br /> Turnarou Time Required 26 DC Level 27 <br /> Normal Rush J I 1 ,--J" II J III J Project Specific (s ec+ ] <br /> 1 Relinquished b Date 7-Zq-4y 1 Received by 28 Date <br /> (Signature/Affdfiawnj Time Oq.:'3 (Signature/Affiliaponi <br /> Time <br /> 2 Relinquished by Date 2 Received by Date <br /> (&i(InaGire/Af iliatian) Time (Signature/Affiliation) <br /> Time <br /> 3 Relinquished by Date <br /> 3 Received by Date _ <br /> (Signatiire/Affdiatmn) Time (Signature/Aff Ration) Time <br /> Comments 29 <br />