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....+s =01417 <br /> a� i I■I■■ i• >• � � � � � � �Fla T1rCHNOLOCY ANALYSIS RE EST AND Reference Document No <br /> CORPORATION CHAIN OF CUSTODY RECORD* Page 1 of <br /> Project Name/No ? t)� , )14 Samples Shipment Date __ � �` -- _ Bill to 5 <br /> —_ L�bf <br /> Sample Team Members 2____ L.� <br /> - -- Lab Destination a _Viv_Iq- <br /> Profit Center No 3 Lab Contact <br /> ,--- N n <br /> Project Manager 4 C( �Z`�� i— Project Contact/Phone 12 7 �� --� --- <br /> s j, �� —- --- -- -- --- Report to `� j <br /> Purchase order No — - �� �/�/ Carrier/Waybill No 13 P - _—' -�u <br /> Required Report Date 11 - <br /> - -- 7770 nlA Sample Sam <br /> Sample�5 Gate/Time�6 ContainerSample� 2p[Number Desan twn/T a Collected T Volume "rRequested Teatang C21 ��apcsa! 22 <br /> f� ram `� t Record No <br /> � /,Jqs lmrb� '�� � , CL <br /> /t1,f�' o <br /> s , I ME <br /> -OS <br /> cs� <br /> �• { - <br /> -0 Cr <br /> L) <br /> x <br /> D <br /> Special Instructions 23CT <br /> Possible lJp rd Identification 24 <br /> -- Flammable Sample Disposal <br /> Non-hazard 25 <br /> Skin Irritant []j Poison B lA Unknown IJ Return to Client FJ Disposai by Lab Archive __ _ n <br /> (mos J <br /> Turnaro nd Time Required 26 '4 C .evel 27 n <br /> Normal- Rcsh`Jm <br /> I II l,j III f•� Project Specific (s e <br /> 1 Relinquished by r Date _ _ _ _ _-- _ <br /> is+gnawro/Afhetionj -- i Received by 2e ate - �U <br /> �- 1 Time rs+gnawra/Aifi�+auuni ✓ Time j �, I <br /> 2 Relinquished 6y Date 2 Received b <br /> 1S+s+Wwre/Arf+haWrnJ Time y Date y <br /> r;;ig++aum■/Affdtauuni Time <br /> 3 Relinquished by Date 3 Received b <br /> i�gndwre/Ah+GaGuui - y Date <br /> Comments 2s Time (&gnau"/Afi&auunl Time <br /> r <br />