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114TERNATIONAL ANALYSIS REQUEST AND Reference Document No <br /> Ila TEMMOLOG <br /> cORPORAMN CHAIN OF CUSTODY RECORD* Page 1 of <br /> Project Name/No 1 ��~ rb 3 Samples Shipment Date 7 f Bill to 5—. <br /> Sample Team Members 2 Lab Destination 8 , ,#f 3 <br /> c , <br /> ,#e—.CA Q503 _ <br /> Profit Center No 3 Lab Contact 9 `ham o <br /> Project Managers �k7keeA �,� Project Contact/Phone i2 ��-�� 33�D 0 <br /> Report to 1U 5 . s 6i t( b <br /> Purchase Order No L-1.5ic 0'.,A A Camer/Waybill No 13 <br /> Required Report Date 1# --- m <br /> M <br /> Sample 14 Sample 15 Date/Time17r-ontaine Samplsl Pro- 19 Asquested Testing 20 Condition on 21 Disposal 22 <br /> Number Descri on/T CollectedVolume servative rem Pmmi Record No. <br /> U01M LY <br /> � m <br /> FL <br /> o <br /> I <br /> cn <br /> maw MM M <br /> M <br /> n' <br /> m <br /> i n <br /> ' o <br /> QI <br /> Special Instructions 23 �I <br /> Possible H and Identification. 24 - Sample Disposal 25 <br /> Non-hazard Flammable E-1SkinI ritant C1J Poison R FJ Unknown <br /> Return to Client Disposal by Lab Archnfe__� (mos ) <br /> n <br /> Turnar nd Time Required 26 C Level 27 <br /> Normal Rushi,J I II I JI III Project Specific [specify)- <br /> 'I Relinquished by 28 Tate 1 Received by 28 Date <br /> (SOFIecure/Affltatton) �:.," ime (agnewre/Afrliawn) Time <br /> 2 Relinquished by Date 2 Received by Date <br /> iSignawm/AFfi6atm) Time (5 iauire/Aifilieruxi) Time <br /> 3 Relinquished by Date 3 _Received bye Date <br /> (ss /Afsuatton) Time (Staneuus/Aft l � Time <br /> Comments 29 <br />