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INTERNATIONAL <br /> TECHNOLOGY R/A Control No. <br /> CORPORATION CHAIN-•F-CUSTODY RECORD <br /> -7 C/C Control No. of j ! `� <br /> PROJECT NAME/NUMBER i,-/21 t 7/dT► �/yE�����-� <br /> J LAB DESTINATION <br /> SAMPLE TEAM MEMBERS'' `9`��i� �� /'`' � M-1 V-\ <br /> CARRIER/WAYBILL NO. <br /> Container Condition on Receipt Disposal <br /> Sample Sample Date and Time Sample <br /> Number Location and Description Collected Type Type (Name and Date) Record No. <br /> 4. <br /> . <br /> - n <br /> t v <br /> �SPectal-instructrons:°=-=~- M~_--`-- - <br /> Possible Sample Hazards: <br /> SIGNATURES: (Name, Company, Date and Time) <br /> 1. Relin uishedB -' L '� �> '' '" <br /> ' '�•' -'` 3. Relinquished By <br /> .Received By: <br /> Received by: <br /> 2. Relinquished By: 4. Relinquished By: <br /> Received By: Received By: <br /> WHITE-To accompany samples <br /> YELLOW-Field copy <br />