Laserfiche WebLink
TioNri. ANALYSIS RE ST AND Reference [foci in ipnl r\Ir W <br /> TE . OLOGY <br /> CORMRA N CHAIN OF CUSTODY RECORD Page 1 of <br /> K <br /> Prolert Name/No !_ �` � �% �� Samples Shipment Date z 315-14- Bill to 5 <br /> Sarrrtrlw Team Members ?_ _ ]fit _ _ Lab Destination f%!�"7 a _ i �,%,' �• ri <br /> Profit Center No 3 C -- Lab Contact 9 �}; <br /> ,i <br /> Protect Manager4__ �L �' i �tiIYC�L, Protect Contact/Phone 12 _ � �[rs,-- - Report ra 1D )�• <br /> Pin ukase Order No _ _C1 4 �� � � _ _ Carrier/Waybill No 1- N <br /> rlPiluu Pit felon Date _ _ -- a 04: ,. 110114 3 <br /> -- 9 <br /> sample 14 Sample 15 Date�me 16 Container Sample 1 Pro 19 Requested Testing 20 Conditinn an 21 (?+wpnwnl 22 <br /> Number Des n/T Heed T Volume sswsdre sin p Aecard No <br /> �0en 6M 1 (OF X <br /> 0 rt <br /> goo, a 3101 C <br /> LT n <br /> C <br /> I <br /> mr. n v <br /> i <br /> U <br /> m <br /> m <br /> m <br /> n <br /> I T <br /> Special Instructions 23 <br /> Possible Halard Identification. 24 Sample Disposal. 25 <br /> Non-hazard Flammable FJ Skin Irritant FA Poison B IJ Unknown IJ Return to Client❑ Disposal by Le Archive [mos 1 <br /> Turnaround Time Required 26 Vel-27 <br /> Le <br /> Norma til Pro <br /> ect m <br /> Specific (specify). <br /> ) <br /> 1 Relinquished by 2 Date 0 1 Received by 2 Date <br /> tS,gnetitre/Affihatlon) Time ls�"/Ar6NetionJ '�� Time <br /> 2 Relinquished bi Date 2 Received by Date N <br /> JS,gnaUue/ArfihetxmJ Time r5Vm m/AW#edoal <br /> Time <br /> 3 Relinquished by Date 3 Received by Date <br /> (9gneUre/Arft wmJ Time <br /> Time <br /> Comments 29 <br /> I <br />