Laserfiche WebLink
'sm � M M M M Ii M <br /> M <br /> RETE DIAT10N 0 <br /> R/A Control No A 1-715'-A <br /> SERVICES , INC . CHAIN-OF-CUSTODY RECORD <br /> C I C Control No -�.— <br /> PROJECT NAMEJ NUMBER AfAc:-+f-g' (4vsivcs /,g,7/,, zs LAB DESTINATION ;� Fl•'�s1v �� <br /> SAMPLE TEAM MEMBERS (� C , CARRIER/WAYBILL NO _ /4fA <br /> Sample Sample pate and Time Sample Container Candrdon on Rrcelpt Disposal <br /> Number tbes6on and Dewriptlon Copeeted Type Type (Name and Oats( Record No <br /> • Lc——SA,-lra' <br /> t ILA YF-q /y L .� �I �-�! <br /> UrC.u- .5'3r-1/7f-ejt-- <br /> F ZU$1b3) _$�4r-► e, v N f 2-� �`r'f 16 3 7 ,h�c�►c- !/'rtt-a-f��* �! FL <br /> I z19133} I o N i' 11-11 - If 3 3J' I✓ VAC.ct- <br /> ZI`l Z S itr^ Powl Z -`'t Ir ► o�L ct- <br /> Special Instructions <br /> Possible Sample Hazards: <br /> SIGNATURES (Name, Company, Date and Time) <br /> 1 Relinquished By ?eo4,( ,art 4 o-el t 0 y s'o 3 Relinquished By <br /> 41 <br /> Received By ti� ��� It - 2U 9 Received By <br /> 2 Relinquished By tzS 12 EY -3' r 4 Relinquished By <br /> r �Received By Received By r <br /> N1in To w=mpany samples <br /> YELLOW Field copy <br /> PINK Ofte Copy i <br />