Laserfiche WebLink
I T I J C <br />TRANSPORTATION, INC:. <br />325OA Du Ran_; Avenue <br />5anl,i Rosa, CA 95407 <br />z <br />Chain of Custody <br />Date:.>?. ,jle,/; � Page t of f <br />: Ilent: �_ ����/ 6' /I `r 112 t'4 <br />Contact ���� � L? d d <br />Tel. <br />Fax: <br />4ddres5: )- <br />GI�' --='a �,=.-�!����c:%�-� <br />State: <br />�?'17 . <br />Zip Code: <br />Project Name: i�� 5 ��, �,< <br />Sample Disposition: <br />Date: <br />Project Manager: <br />Sampler(s) Signature: <br />Due Date o Regular ❑ Rush Days <br />Approved By: <br />Sample Description <br />Lab <br />ID <br />Date Time <br />Collected <br />Matrix <br />No. of <br />Containers <br />Analysis Requested <br />J%fiafry <br />;£:SEH"'% <br />' <br />CraMt'7, T P01 <br />6-u$ fwc"—rV') <br />�sr&x <br />I <br />I <br />Sample Conditions. Seal ❑ Intact ❑ Broken ❑ None; Temperature ❑ Cold; ❑ Room; <br />Other <br />- <br />Relinquished by (Signature) t,' <br />Received by (Signature),,(-�•,� <br />Date/Time <br />Relinquished by (Signature) <br />Received by (Signature) <br />Date/Time <br />n <br />Relinquished by (Signature) <br />Received by (Signature) <br />Date/Time <br />i z <br />Relinquished by (Signature) <br />Received by (Signature) <br />Date/Time <br />,4 ` .z <br />SPECIAL INSTRUCTIONS <br />l }til+ G ' .. c�(✓n� � c{� ��Gt.i`� �tv� <br />I �� 1. yI � G �GEl�I a �. eFr% <br />i P,I I <br />z <br />WHITE COPY - Client YELOW COPY - Labortory PINK COPY - Courler BLUE COPY - Fite <br />M <br />rj <br />A< <br />ITr <br />