Laserfiche WebLink
e <br /> i <br /> f: <br /> 1I <br /> WH <br /> a <br /> INTERNATIONAL <br /> TECHNOLOGY CHAIN-OF-CUSTODY RECORD Control No. <br /> CORPORATION <br /> CIC Control ado. I <br /> PROJECT <br /> IVA!".✓NUMBER LABDESTINATION <br /> SAMPLE TEAM MEMBERS C► e { <br /> CARRIER/WAYBILL NO. Ov <br /> Sample Sample Date and Time Sample Container <br /> Number Location and Descriplion Collected T Condition on Receipt Disposal <br /> YPo Type (Name and Date) Record No. <br /> .. ' t f <br /> I <br /> t� 5. <br /> Special Instructions: __ Y <br /> Possible Sample hazards: <br /> SIGNATURES: (Name,Company, date and Time) 0 <br /> '. Relinouished 8y: p Q <br /> 3. Relinquishe y /4' <br /> O P'd71 S' <br /> Received By: <br /> Q Received by: <br /> -- - <br /> 2. Relinquished By; 4 Relinquished By: - ,+ <br /> Received Received By: _ <br /> WHITE•To newmpany somplq <br /> YELLOW Field copy ; <br />