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i <br /> d , <br /> INTERNATIONAL <br /> I 1W TECHNOLOGY CHAIN-OF-CUSTODY RECORD <br /> RIA Control No. _1 5f 9 5,7�,' p .` <br /> CORPORATION <br /> C/C Control No. 197895 <br /> �-�,� y� '' ' <br /> PROJECT NAME/NUMBER ✓ru'1s�t71V 1/I clO �O 3 LAS DESTINATION __f r x-C;4' t PI' <br /> SAMPLE TEAM MEMBERS N&3S <br /> CARRIER/WAYBILL NO. •' <br /> Sam !le <br /> P Sampla Dale and Time Sample Container Condition on Receipt Disposal <br /> Number Location and DAscriplion Collected Type Type (Name and Datel Record Nn E r <br /> 5S-P.3-3 T I C r 3 — C-PAI 05 G -6701+ SQVI- Ix •`G`i?R4ss <br /> 513 PILE 3 - C-o w•Peel ---Q7/0 <br /> 55- - f LC (NA"P051fC 3YA191 2- <br /> Q7 5 D <br /> - <br /> 75D <br /> S- G 4 t�D►k <br /> Po-, IT 3 6V - 69-60 <br /> 95224 <br /> 9 <br /> - i <br /> Special Instructions: `<< _— <br /> 'Ossibfta Sample Hazards: <br /> r <br /> SIGNATURES: (Name,Company,Date and Time) <br /> � y <br /> t. Relinquished By: �• 3 — IS�B 3. Relinquished By: r <br /> Received By: i j <br /> I •-• -- _ Received by: r <br /> I I,q <br /> 2. Relinquished By: 4. Relinquished By: �i <br /> Received By, t <br /> Re.;aivc J By: <br /> I � <br /> WHITE-To'acr--^oany samples ay <br /> YELLOW-Fid y _ <br /> _ ( 1 <br />