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Q }}}} 3 <br /> Project Name/No RW3 _�r Samples Shipment Date 13,11 to sr %f <br /> Sample Team Members 2 '] Lab Destination $ 'Id � <br /> Profit Center No. 9 .SIC- Lab Contact 9 S�rA <br /> ��� l ,f 3 <br /> Project Manager4 f" H� �w a Project l ntact/Phone i2 �� Report to 10 <br /> Purchase Order Na s 3 /l _ Carr�er/Waybill No. 13 — <br /> Required Report Date I _ — — '----� <br /> r • l r r r — @ <br /> Sample 14 Sample 15 Date/Time Carrtainerl smplsl �r� 19 Asquested Tasting 20 Condrtion an 21 Disposal 22 <br /> Number n/T Ilecud Volumes servathm ram Receipt Aecard No <br /> Sc1 � � 1 L N Y6,'12x S1 - <br /> r� FOR <br /> it) In <br /> CL <br /> UZ3C LT r, <br /> 0 <br /> 1 1r.E if NJ U <br /> m <br /> rn <br /> r► t1 <br /> e <br /> ,a <br /> C� <br /> x <br /> H <br /> 4 <br /> Special Instructions. 23 <br /> Possiblea and Identification: 24 Sample Disposal 25 9 <br /> Non-hazard Flammable TJ Sion Irritant Poison 8 ❑ Unknown 1� Return to Client Disposal by La Archive��_� (mos ) m <br /> TurnarotAnd Time Required 26C Level.27 m <br /> No:rna _ Rush I II IJ III I-J Pro ect Specific (specify)— _ 5 <br /> `s,BnRelinqushed by 2 + Date u 1 Received by ? ©ate <br /> Time (s�pnetue�affihetaeni ) / Time <br /> 0 <br /> 2 Relinquished b _ Date 2 Received by 0 Date _ N <br /> (Srgnsurre/Aflihatunn) Time t "/A1fwadon) Time <br /> 3 Relinquished by Date 3 Received by Date <br /> ISignswre/Affihewn) Time Iff9natLa/Arne") <br /> Time <br /> Comments 29 <br /> ARCA lei SM <br />