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NAI. �� �—�; " _,�-*i ��--*� ��� �I_t.�-`��;� .� <br /> �•• ANT�LYSI Ei,, STr AIVD UR"eterence �ocumen N( '_7, 69, 6 <br /> CORPORAMN �ocds CHAIN OF CUSTODY RECORD* Page 1 of <br /> t <br /> Project Name/No._i_ I A _1VZ Samples Shipment Date 7 Bill to:S ` t�' '�' `-�'` _2 <br /> Sample Team Members 2 Z� Lab Destination <br /> Profit Center No. 3 Lab Contact 9 rNi n <br /> Project Manager41,i. \M Project Contact/Phone 12 o r ,r , 3 <br /> Report to: �� Go` Ol. <br /> Purchase Order No, 6 w s t1 .N4����� Carrier/Waybill No. 13 <br /> Required Report Date 1 . � � 3 <br /> r <br /> li�tgS�t� 71iw�(�tiitll-a. �l� i1�1 �X <br /> Sample 14 15 16 I 5i1 1 <br /> 2Q 21 Dieps.e.a..i. <br /> 2 <br /> 2Sam !e Dste�me Container pie Pro- Testing Condition anam <br /> Number Description/TypeCollected Type me servative Pram ReceiptRecord No. <br /> otiStJODr 58143 <br /> I � . <br /> 58144 <br /> I biRSMw [1`1 <br /> � ��L�er �s vca t ti, , - � o:c, 58145 � i <br /> k <br /> jX t L"f l �I " f��2u-t <br /> � Lt <br /> ti 5846 <br /> � Ti � r1 -Ca jJ U 1 i <br /> 5 k <br /> _J 1 <br /> k L� �-- rf -I L 2 L a;4ua :.r x9 <br /> i11� 7� i ��Mil T� li-lJ / W y�j( - .,: ..' re'. ., „...s ,; •�— <br /> 'R 017 <br /> C <br /> Cr <br /> 10 <br /> 0 <br /> Special Instructions: 23 <br /> Possible Hazard Identification: 24 _ _ Sample Disposal: 25 0 <br /> Non-hazard ') Flammable -J Skin Irritant J Poison B J. Unknown J Return to Clientb oral Ois <br /> J p y LabJ Archive (mos.) ro <br /> Turnaround Time Required: 26 GIC Level: 27 _ v <br /> Normal rJ Rush'J I. J II.-J Ill.J Project Specific {s eci j _ N <br /> 1. Relinquished b '$ Date: ►qc�2,� 1. Received by 28 Date: <br /> (Signature/Affiliation) Time- 1 (Signature/Affiliation) Time: `�—*- <br /> 0 <br /> 2. Relinquished by Date: 2. Received by Date: <br /> (Signewre/Affiliation) Time: [Signature/Affiliation] Time: <br /> 3. i <br /> Relinquished,b�Lds nrr�,�� Iia 3. Received by Date: <br /> (Signature/Affllietion) - �l.y�..�{4�t1 i4� _ (Signature/Affiliation) <br /> . _ Time: <br /> Comments:29 <br /> MCA sn 5/9i <br />