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V—j L -i <br /> �;C <br /> .TIONxr. : ANALYSIS REaU�.�T"AND X; 3�$g Reference Document No,. , U 3,18 <br /> �.TacHkoi.oGr;." CHAINGF CUSTODY-"RECORD* page 1 of <br /> CORPORATION� . : - <br /> Project Name/No. i ?- a ]; - g Samples Shipment Qete 7 A,,,� 3� { Bil!'ta:5 -f 6"o c'v"l I c <br /> ample Team Members 2 D. fIECI Lab Destination.e��,e~^-f 6 L� �"'"`�c�' 3 `-v b o l- <br /> I.,ti ter- ,T i ..l E - cr A f <br /> Profit C'snter No."3 " 3�+�'l 4 k Lab Contacto +?+•tit-' ,.� �E <br /> Project Manage, o,41 S _ _ _ ProjecC Contact/Phone 12� i II'L� t�-'`� Report to:1. � ra-,s "� ✓� _ <br /> Purchase Order No.s Carrier/Waybill No. is "vP o r o f- 6 <br /> I' <br /> Required Re ort Date 1 ` " . " <br /> 4 P • • + <br /> sample 1.4 Sample I V' " babe/'1amI6 f ontainw. Umptej" � 19 Requested-Testing ?4 CdndlthM an 21 b#eposel 22 -r <br /> Number beacrl tion/T Colhwted - - Volume sarw on p ram" "Weig. Record No. � C: <br /> 78185 in <br /> FOR -- 3 QJ <br /> 0 0 <br /> a <br /> cc <br /> A IM ,+ <br /> h" <br /> S ecial InstruCtions: 23 <br /> K Possible Hazard #dBntifICBVDn: 24 Sample Disposal: 2 <br />'r Nan-hazard Flammable Skin Irritant [a Poison B Q Unknown Return to Ment IJI Disposal by LeA Archive (moa.) <br /> Turnaround Tim quired: as 1. g �:�,"�""s" QC Level: 27 <br /> . Normal Rus " ------�-~' I, II. III.,- Project Specific[specify) <br /> 1. Relinquished b&28 ' Date: 1. Received by 2r' Date: & -36-Z+ <br /> iSgnabure/ARilletlon)" Tlfll$: �j �6ignau—/lffiIIaknj r jCL4r Time: I <br /> Ln <br /> 2. Relinquished by Date: 2. Received by Date: ro <br /> i9l�eburff/AfAliatian3... _ : TI[�le:..- . pure/Affiliation)." Time, <br /> 3. Relinquished by Date: 3. Received by . " :" Date: <br /> ' 15��,ea,rsiwrua Time: (9gneu?m/AMh6on) Time: <br /> m <br /> "' <br /> Comments:29 <br />