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ZO <br /> 7WATIONAL ANALYSIS REF STD Reference Document _ <br /> TECHNOLOGY <br /> CORPORATION CHAIN OF CUSTODY RE ORD* Page hof . <br /> Project Name/No i p3rl 14 _ <br /> Samples Shipment Date ? _ f b_ S _ <br /> p P ,� __�_-- 8111 to _ --__ _ <br /> Sample Team Members z 'G�% Lab Destination 8 ���1✓�__— l — <br /> a <br /> Profit Center No 3 --- L— Lab Contacts ---- <br /> Prolect Manager4 bz�7-k e1i Project Contact/Phone 12_ 7 = a <br /> s , i -- � - -- Report to 10 -- - - ------ - - - - _- <br /> Purchase Order No _ � l --— -__ Carrier/Waybili No 13 _ -- _ _ _ _ - - -- — -- - -- <br /> Required Report DateEn <br /> ----- <br /> m <br /> Sample 14Sample 15 Date�rne 6rntainerSample Pre- 79usat <br /> ed Testing 20 Condition on 21 Disposal 22 <br /> Number Descn tion/T llectedVolume servatwram Receipt Record No <br /> -, <br /> UDC U ULT n <br /> 0 <br /> rn <br /> CD <br /> m <br /> Cr <br /> n <br /> 0 <br /> Special Instructions 23 <br /> Possible a and Identification 24 Sample Disposal 25 9 <br /> Non-hazard' Flammable l-_J Shin Irritant l Polson s Unknown Return to Client FA Disposal by LabX Archive__ --__ (mos ) 10 <br /> n <br /> Turnaround Timequlred zs ht :3� QC Level 27 <br /> Normal J Rush; 6 II IJ III FJ Pro ect S eclflc (s <br /> 1 Relinquished by 2e f'1 ,Date - Af 1 Received by 28 Date l - <br /> ftnature/Affihauanl iSignau"/Afihauunime <br /> o� <br /> 2 Relinquished by Date _ 2 Received by Date <br /> fti lutum/Affihuuonl Time iS{gnature/Aff{hdtMJ Time <br /> 3 Relinquished by Date _ __ 3 Received by Date <br /> iS 9naUwe/Aff{hduonJ Time ISlgnnture/AfShauunl Time <br /> Comments 29 <br /> 5 <br /> �{f`A 9i4�11 <br /> I <br />