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INTERNATIONAL R/A Control No. <br /> TECHNOLOGY CHAIN-OF-CUSTODY RECORD <br /> CORPORATION <br /> 265176 <br /> ,y C/C Control No. 2 6 517 6 <br /> PROJECT NAME/NUMBER � `�T����� 19Q�q L Z LAB DESTINATION <br /> SAMPLE TEAM MEMBERS • e-Q"tJ92 CARRIER/WAYBILL NO. <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 /> 01A t, 4-P,-r . l it -1 l <br /> Off/} nca 5 <br /> O 3a <br /> 0 SA Lo OCSP <br /> OSA + aL 11O2 <br /> o 7 tt 1455 <br /> OSA al�k_ 0 V1511 <br /> d /A IS1 <br /> 10A + pu IS7C [i <br /> //� 11c4P�13 ^'APs- • 'a-- Soy V1. 4 �1 153`V `^'�, +nsS Sa3et <br /> Speciallnstructions4- 9A hr- -_-L) <br /> Possible Sample Hazards: <br /> SIGNATURES: (Name, Company, Date and Time) 07,30 <br /> 1. Refn uished B ��-2- ---��o L + �� ��ISI9( <br /> q y: � cQ 3. Relinquished By: <br /> Received By: �T /6CZ2167 v Received by: <br /> 2. Relinquished BByyfff n� f S '!/ 7S.S 4. Relinquished By: <br /> Received By:19A o� d✓ � As IVS t/ O Received By: <br /> WHITE-To accompany samples <br /> YELLOW-Field copy 127A-10-85 <br />