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INTERNATIONAL C I S 1� ( , I v (1$584 <br /> TECHNOLOGY CHAIN-OF-CUSTODY RECORD <br /> ED <br /> R/AControl No. <br /> CORPORATION 265178 <br /> C/C Control No. <br /> PROJECT NAME/N UMBER `�iR Z.ZLABDESTINATION me-rA -T6y <br /> SAMPLE TEAM MEMBERSCARRIER/WAYBILLNO. <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 �.1 l I>I <br /> o , <br /> I0tt 1 <br /> CEIISPA <br /> Ili <br /> t <br /> k .¢._ 1 t3 <br /> 0-7A <br /> Oft tot <br /> Special Instructions: <br /> Possible Sample Hazards: <br /> SIGNATURES: (Name, Company, Date and Time) <br /> �r _ o �L>,�L-,-T�i nn,-r� 11��19t 3. Relinquished B <br /> 1. Relinquished Br/y�! �n5 ,-- - q Y: <br /> Received By: R "� 1n , n I 1 t�O^ ( �9 r Received by: <br /> 2. Relinquished By: 4. Relinquished By: <br /> Received By: Received By: <br /> WHITE-To accompany samples <br /> YELLOW-Field copy 127A-10-85 <br />