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M M � M M M �4*r��e M M � � <br /> TJ7rATIONAI, ANALYSIS RE EST AND Reference Document No 500342 <br /> AWN CHAIN OF CUSTODY RECORD* Page 1 of l <br /> va�, ��,-, 3�1�, Ct�ods <br /> Project Name/No 1 7� 7�b,a' _ _ Samples Shipment Date 7_ / q —_` 5 Bill to <br /> 1 � ---�T <br /> Sample Team Members 2 -, �.Q,' -- Lab Destination e m��m_ <br /> Profit Center No 3 `1 is <br /> _ Lab Contact—EL-Z� �_a,— <br /> Project Manager 4 j-,_ �{afj�'fa5 _ Proect Contact/Phone 12 , 1 71,- IOb _ 0 <br /> Purchase Order No s- Carrier/Waybill No 13� <br /> Report to 10 <br /> Required Report Date <br /> Sample 14 Sample 15 Date�me 16 Container' Sample 1 pry 19 Requested Testing 20 Condition an 21 - TDisposal 22 <br /> Number Dae tion/T T Volume Collected aarvatinro P ram q t <br /> Record Na. <br /> a q 6 5 ?•� 9 i4 Q+�.b T P H -T)%%,s k i m <br /> SpA 65360 <br /> W� %-JZ.-.ICtb txIL-1r ��. T4� - Ditse.l 65361 <br /> Itof FPr, wvS- '614 t1Vfl S0 t5 o <br /> o v., � IT?' r W, a <br /> �w 1 v ' 65362 <br /> I Lfi + i 0 -D y Oil k J <br /> ��,,,, 65363 <br /> o5�a 6�'►W3 s�oo� tx1t�- f 1 N TQ - oIU <br /> 43-pits�SI ; • 65364 <br /> s <br /> 65365 0 <br /> Special Instructions 23 O F F- H&LD 5/zY,46 P� G.F. i 65366 0) <br /> Possible Hazard Identification 24 Sample Disposal 25 3 <br /> Non-hazard I Flammable IJ Skin Irritant fj Poison 8 1.1 Unknown FJ Return to Client fJ Disposal b Lab l <br /> P Y Archive __ _ _ (mos ) 0 <br /> Turnaround Time Required 26 0C Level 27 -- <br /> Normal �� Rushl-I I l II�� III U Project Specific (specify), _ m <br /> 1 Relinquished b Date _ ?,?. _ 1 Received b 28 <br /> iSgnature/AffihawnJ —-- y Date rJ 221 Q <br /> Time 5 'iS n1 (S�gnar„re/Affthatwn) -- <br /> 2 Relinquished by Date _ J4" Time •J <br /> 2 Received by e <br /> ftnature/Arfihabun) Time (Signawre/Affihaunn) Date <br /> - - --- — <br /> Tim <br /> 3 Relinquished by Date _ _ _ _ 3 Received by pee <br /> (8,gnawm/ANihatwn) T m [Signature/AHiheuon) - - - <br /> rt•,, , , , Time <br /> Comments 29 JP;[/'' W PP c %1,v VE <br /> �� ^uVDIriOF� <br /> APPROPRIATE '�— 4 <br /> r + <br />