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ED <br /> INTERNATIONAL I ► <br /> TECHNOLOGY .53328 R/A Control No. \ <br /> CORPORATION CHAIN-OF-CUSTODY RECORD <br /> C/C Control No. 129569 <br /> PROJECT NAME/NUMBER 'RZ—kt , -l;wya1J k c`o \ CP� Vl LP LAB DESTINATION <br /> SAMPLE TEAM MEMBERSCARRIER/WAYBILL NO. �- 1 <br /> Sample Sample Date and Time Sample Container Condition on Receipt Disposal <br /> Number Location and Description Collected Type Type (Name and Date) Record No. <br /> Special Instructions: y A <br /> Possible Sample Hazards: <br /> SIGNATURES: (Name, Company, Date and Time) • <br /> 1. Relinquished By: — `� � �^�L 2_—t --zq—ct �c�v3. Relinquished By: <br /> Received By: /+—,L/ by: <br /> 2. Relinquished By: 4. Relinquished By: <br /> Received By: Received By: <br /> WHITE-To accompany samples <br /> YELLOW-Field copy <br />