Laserfiche WebLink
'NMN(; <br /> QUALITY ".-ALYTICAL LABORATORIES CHAIN OF CUSTODY RECORD AND AGREEMENT TO PERFORM SERVICES <br /> CI-12M HILL Project# Purchase Order# LAB TEST CODES SHADED AREA--FOR LAB USE ONLY,.I <br /> 1 �t1T.. �� �- I Lab Lab tiJU �)U J �. .�L�Tr-�)�J i - <br /> Project Name <br /> �� N B # Quote# Kit Request# <br /> Company Name/CH2M HILL Office } <br /> cS Fo F I! <br /> ANALYSES REQUESTED <br /> Protect t�annager 8 Ph # Report Copy lo: Project # <br /> Mils.EJBr,2.AJ c rN kEN LF�w�S SFo F <br /> Dr. & Z 1�� / O j s <br /> i <br /> Requested Completion Date: Sampling Requireme]IERDisposo <br /> Sample Disposal: N i No.of Samples Page of <br /> C5 SOWA NPpES RCRA OTReturn A <br /> El El <br /> 1:1 El 13 <br /> Type Malrlx E \A t`; \�` i i i COC Rev Login LIMS Ver Ack Gen <br /> Sampling C!G WIS CLIENT SAMPLE 10 R <br /> S <br /> M I A T OI (9 CHARACTERS) <br /> PiB E ^ L i LAB ! LAB2 <br /> Data Time R ; i ; REMARKS <br /> I I ID ID <br /> - _ Z __ -- <br /> -.-. _. <br /> By b tie iPle sr sign and nl name) Date I e $n4quW <br /> (Please aY and print nsmel i Da p! a HATWRAPINESSA• Y N <br /> . - LJ Q <br /> R ed B iP se sign a print name) — —�` i at !Time QC Level 1 2 3 Other: <br /> y D to Ime [Please sign and print name) - <br /> COC Rec ICE <br /> Received By Mailsa slo+una pllnr.lantal Date/Time Relinquished By IPleeae abn and pflm eaa,o) Datellime Ana Req TEMP/v <br /> ! Cust Sea Ph <br /> �j Re e0 8y and print nmol DatelTlme Shipped Via Shipping# <br /> UPS BUSed- Hand Other <br /> �.► Work Authorized By V IPleesa sign and print name) Remarks <br /> Instructions and Agreement Provisions on Reverse Side <br /> DISTRIBUTION:ORIGINAL-LAB,Yellow-LAB,Pink-Client <br /> REV 11102 FORM 340 <br />