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NNAM �AFA&rw RM-erffootmerR944111111101" � <br /> ffL—rl <br /> RATION CHAIN OF CUS Y R C RD* Page 1 of <br /> Protect Name/No _ Samples Shipment Date 7 t Bill to 5 <br /> Sample Team Members 2Lab Destination e_ �— <br /> Profit Center No 3 51 � Lab Contact 9 <br /> -- — _— <br /> Project Manage r4 �'�ct Project Contact/Phone t2( 10 „zt e �r �� <br /> s �4� rl� �3 — Report to --__..--..5_�----.L�- �t <br /> Purchase Oi der No _ —_j Carrier/Waybill No <br /> Required Repiwt [late i � + 121A . <br /> — - --- -- <br /> Sample 14 Sample 15 Dote/Time, Container) Sample) Pro- 18 Requested Testing 20 Condgbon on 21 Wspnsal 22 <br /> Number n Collected T Volume oorwa ram Reae Record No. <br /> 0 v m <br /> 0 <br /> U Z111 r. LT C3 <br /> i <br /> u <br /> n <br /> n <br /> e <br /> M <br /> r <br /> x <br /> C <br /> C <br /> a <br /> Special Instructions 23 <br /> Possible He and Identification: 24 Sample Disposal 25 u <br /> Non-hazard'JU Flammable FA Stun Irritant U Poison B U Unknown 17A Return to Client 13 Disposal by Let Archive (mos 1 a <br /> r <br /> Turners nd Time Required- 26 GC Level 27 <br /> Normal 4 Flushi j II U III l --Project Specific (s eci ) vi <br /> 1 Relinquished bP—IT <br /> g J f Date. ` VP 1 Received b $ Date C <br /> [sVwwmiAffifwwnJ �-- '� Time J&W.1.1ArfihW.J �� '' 1 Time c <br /> 2 Relinquished Ly Date p. Received by Date <br /> (Sg-u re/AtF&t ani Time IftrwWM/Affiaerbnl Time <br /> 3 Relinquished by Date 3 Received by Date <br /> ftnatumiAffilisuml Time Time <br /> Comments "s <br /> MCA 9115191 <br />