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INAbATIONAL ANALYSIS RE ST AND Reference Document Noo 6 8 1 16 <br /> TE OLOGY CHAIN OF CU at RECORD* Pae 1 of 3 " <br /> Coi PORA �A <br /> TION / 9 <br /> 2�.lhS�YJd � <br /> Project l` ame/No 1 � Q40!-LA- Samples Shipment Date ? � �Ot� _ _ Bill to T Po2Aep+Of1i _ <br /> Sample Team Ambers 2 K__)6jA1,Q 9_ _ Lab Destination a <br /> Profit ( anter No 3 Lab Contact sO ——____-__ SPQ, •xrv. -ru _ 3�_ 8 <br /> Projec Manager43.2�? Project Contact/Phone 12 Report to 1_ -K�l.�� <br /> u a <br /> _ _--m <br /> Purchase )rder No 6 Carrier/Waybill No 13 <br /> Required R1 )ort Date 1dab �✓ ' <br /> ro <br /> Sample I Sample 15 Date/Time f s Cuntainerl Sample 1 Pre- 19 Requested Testing 2f] Condition an 21 Disposal 22 <br /> Number Dsecre twn/T a Collected Y e Volume ser+lat+ve Program Receipt Retard No <br /> U , <br /> VUR In <br /> FJ� � �� iCo•DO 3 v0 L nit 6,( � <br /> � -ot <br /> ° O n <br /> z. 1C,1tr <br /> Cr <br /> Special Inst ructions 23Er <br /> CQ <br /> Possible H. zard Identification 24 Sample Disposal 25 <br /> Non-hazard J Flammable J Skin Irritant IJ Poison B J Unknown J Return to ClientDisposal by Lab Archive_ _ (mos ) co <br /> Turnar c Time Required 26 00 Level 27 <br /> Norma! Rush _J I I IJ 111-1 Ill 1 iJ Project Specific (specify). <br /> 1 Relinqufsi pedb 2 Date • /'?• 1 Received by 2 <br /> [signature/Affdied, ii Time (sgnewre/Affivatron) Time Q 0 <br /> 2 Reiinquis[led by Date _ _ _ 2 Received by Date <br /> [signature/Affifiatu ) Time [5ignMrs/Affilietgon] Time <br /> 3 Relinquist led by Date _ 3 Received by Date <br /> (Sgnawre/Affdnau. ii Time iftneWm/Affihatron) Time. <br /> Comment: 29 <br /> MCA 3115181 <br />