Laserfiche WebLink
INTERNATIONAL 53328 <br /> ED TECHNOLOGYR/A Control No. <br /> 3Gl ��1 <br /> CORPORATION CHAIN-OF-CUSTODY RECORD <br /> y� 11 C/C Control No. <br /> PROJECT NAME/NUMBER LAB DESTINATION �ZZ AS r-- <br /> SAMPLE <br /> SAMPLE TEAM MEMBERS CARRIER/WAYBILL NO. �'u o xf �OG�00 <br /> Sample Sample Date antl Time Sample Container Condition on Receipt Disposal <br /> Number Location and Description P <br /> P Collected Type Type (Name and Date) Record No. <br /> x l C"t7q Q ) V. 4"I'Ve E�=--TA1 15L�O S-e I- F�vsiy acVe �J <br /> L Cq-7g ESZ) j _ �nTX ©t= r z sf—B- tSIS So, 1 1- �" Phi Ire e <br /> Special Instructions: -4-Q <br /> Possible Sample Hazards: t-k V--) it - -k-�t`� <br /> SIGNATURES: (Name, Company, Date and Time) <br /> 1. Relinquished By �ti� Zrt - -�`� O�v 3. Relinquished By: <br /> Received Ed <br /> O ZT�S <br /> �"-- � Received by: <br /> 2. Relinquished By: 4. Relinquished By: <br /> Received By: Received By: <br /> WHITE-To accompany samples <br /> YELLOW-Field copy <br />