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CHALWOF-CUSTODY RECORD <br />AvEmec© • <br />A Coming Company <br />PAGE OF <br />SAMPLER: tSignature) <br />J <br />SAMPLE DESCRIPTION <br />DATE SHIPPED <br />CARRIER <br />LL.l - <br />O <br />r /9 <br />PTIE;NE <br />AIRSILL NO, <br />'USTOOY SEAL NO'S <br />COOLER NO. <br />r, �,: - � <br />SHIPG <br />41 <br />� r 9L � a= -•-I d 'S:ol pec % �6� <br />CLIENT NAME <br />TO: pc� �,� 0 -'4. <br />���..� O� <br />U)SL <br />� <br />COMPANY <br />i 6 e' C11 <br />co 11� d Q <br />u� <br />r6, 5 cpa G e <br />ADDRESS <br />I <br />I <br />TDIS <br />Uj <br />y44� <br />PHONE NO. <br />❑ <br />W <br />V7 <br />PROJECT NAME <br />PROJECT NO. <br />P.O. NO. <br />�! <br />c <br />FIE,qNQUISHEDBY(Si na+ure) A <br />ECEIVED BY latureJ <br />DATE <br />TIME <br />RELINQUI ED 8Y (Signature) <br />RECEIVED BY (Signa+ ) <br />DAT <br />TIME <br />RELINQUISHED BY (Signarure) <br />RECEIVED AT LAB B (Signature) <br />DATE <br />TIME <br />RELINQUISHED FROM LAB BY (Signature) <br />RECEIVED BY (Signature) <br />DATE <br />TIME <br />ANALYSIS REQUEST <br />SAMPLE ID NO. <br />SAMPLE DESCRIPTION <br />DATE/TIME ANALYSIS REQUESTED <br />SAMPLED <br />SAMPLE CONDITION <br />UPON RECEIPT <br />LL.l - <br />�'. • '' �-2z <br />r /9 <br />�T qa SIo s L, c, 4,- <br />r, �,: - � <br />( <br />� r 9L � a= -•-I d 'S:ol pec % �6� <br />i 6 e' C11 <br />u� <br />r6, 5 cpa G e <br />I <br />I <br />TDIS <br />SPECIAL INSTRUCTIONS, UQMMEN I S: <br />1O -S-6 d 1 cl P/& c e_ u I iie 4J 5c_ t 4e.. 164 <br />C' <br />ofs� <br />NOTE: UNUSED PORTIONS OF NON -AQUEOUS SAMPLES WILL BE RETURNED TO CLIENT. <br />EXPECTED Immediate <br />ANALYTICAL Attention (200% Surcharge) RUSH (50-100% Surcharge) Standard <br />T.A.T.'S <br />ENSECO EAST LOG NUMBER (lab use only) <br />ENS -1045-B <br />Client Retains White Copy Only <br />