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0%,Enseco <br /> PAGE OF <br /> CHAIN-OF-CUSTODY RECORD A corning company <br /> SAM : DATE SHIPPED CARRIER <br /> PL,FAPHME 1111 NO. CUSTODY SEAL NO'S COOLER NO. <br /> SHIPp CUENT NAM <br /> o � <br /> 1 0 LA <br /> TO: �Cm 1� e� � N COMPANY <br /> d� - lyc4' Q3 �P 7ADDRESS GJ <br /> ❑ ❑ ❑ ❑ W PHONE NO� 1&, 057 0� <br /> PROJECT NAME PROJECT NO. P.O.NO. <br /> RELINOU99HED BY(SOWFft e) RECEIVED BY(Signature) DATE TIME <br /> RELINQUISHED BY(SOMA") RECEIVED BY(Signature) DATE TIME <br /> REL7 UISHED BY(Signature) RE EIVED AT*AB BY E8ttyrature) ! . _ ATE+ _ TIME <br /> RELINQUISHED M LAB BY(Signature) RECEIVED BY(Signatu DATE <br /> ANALYSIS REQUEST <br /> SAMPLE ID NO. SAMPLE DESCRIPTION DATE/TIME ANALYSIS REQUESTED r 'SAMPLE CONDITIOI, <br /> SAMPLED UPON RECEIPT <br /> 4zq'� <br /> Ci <br /> I/1 W 3 y�-�`� 13 - �- r L o <br /> -,7D— <br /> SPECIAL <br /> , <br /> SPECIAL INSTRUCTIONS/COMMENTS: - _ • <br /> a <br /> do <br /> • •♦ <br /> • . <br /> • <br /> Ilk <br /> •• : UNUSED PORTIONS OF NON-AQUEOUS SAMPLES WILL BE RIETUR TOC NT. <br /> EXPECTED •'dw Immediate RV H (50-100% Surchar&) Standard <br /> ANALYTICAL Attention (200% Surcharge) <br /> T.A.T.'S • <br /> ENSECO EAS71,66DUMBER (lab use onl)j IL • <br /> �J�iws a <br /> Al <br /> Cl, e Copy Only <br />