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j <br /> - i <br />F7 <br /> INTERNATIONAL RIA Control No. <br /> TECHNOLOGY CHAIN-OF-CUSTODY RECORD <br /> - CORPORATION <br /> � C/G Control No. 197897 <br /> PR03ECT NAMElNUMBER LAB DESTINATION ' <br /> SAMPLE TEAM MEMBERS _ if8 1 Lf CARRIER/WAYBILL NO. 4, <br /> Sample j Sample date and Time Sample Container Condition on Receipt Disposal <br /> te} Record No. i <br /> NumType (N9me and Da <br /> pe•. Location end Description Collected Type .... <br /> ,i <br /> "SS-I'2. z L ��o I L P — oqio <br /> Pz_I`l <br /> l i� ud <br /> L F- <br /> I� " l53a <br /> — a <br /> 15 k4 o <br /> - 5;u y <br /> Special instructions: <br /> Possibi6 Sample Hazards: <br /> SIGNATURES: (Name,Company,Date and Time) <br /> J. <br /> IN <br /> 1� <br /> 1. Relinquished By: 4, `" 1`{l Ij ` Mr 3. Relinquished By: � <br /> —1 x.I �3 z� I �k � a <br /> Received By: ) } Received by: ; <br /> j�?`' -h;`ll 4. Relinquished B <br /> 2. Relinqulished By �i E -- q Y' <br /> Received By: J �k,',�' f t `�.1 I`.;�, deceived By: - <br /> WHITE-To a,� any samples <br /> YELLOW-Fief <br /> I 1 <br />