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Columbia <br /> Analytical <br /> Courier Sample Receipt Record SerVIceS'nc <br /> Date <br /> Company E<Y►1Gd� <br /> Project No _ 2-z-3- civ/ L,;- C/o 7-,9 vo Y <br /> Number of Containers Coolers Boxes Other <br /> Custody Seal(s) Present5(! \O Custodv Seai(s) Added YES NO <br /> Containers Relinquished By- Simea \ame �•.�, _ /� � <br /> Pnntea \ame ; ,,,,�� ,1 / 7�11(z-4 <br /> Companv C�`-mit/ <br /> Date and Time o <br /> o::"_r.:+e.s Reccsvee- 3y (Coy-:::er) SImed Fame � <br /> Printed Name <br /> Companv <br /> Date aria Time r // Z <br /> Containers Relinquished By (Courter):Signed Name <br /> Pnnted Name <br /> Companv <br /> Date and Time <br /> Containers Received By(Lab): Sio ned Name <br /> Pnnted Name <br /> Company <br /> Date and Time <br /> Note Samples received via couner wdl be orTiclalh received and processed at CAS' Sample Receiving Office <br /> 1921 Ringwood Avenue. San Jose. California 95131 <br /> Telephone: 408-337-2100 Fax: 408-437-9356 <br /> COUR]ER2 DOC 4/7195 <br />