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r " %EnsecorP_AGE OF <br /> CHAIN-OF-CUSTODY RECORG A Coming Company <br /> SAMPLER:(Signature) DATE SHIPPED CARRIER <br /> ' -f—Z ":' <br /> pNE AIRBILL NO. CUSTODY SEAL NO'S COOLER NO. <br /> SHIPOTO: I CLIENT NAME <br /> a O B F <br /> cY ICOMPANY <br /> Oj •p v 0 0• 8 0 v Q J <br /> Q <br /> ADDRESS <br /> LU <br /> �° �. '�� m � D• to <br /> C_ <br /> ❑ El ❑ ❑ W PHONE NO. <br /> N <br /> PROJECT NAME PROJECT NO. P.O.NO. <br /> �! D <br /> RE�yQUISHED BY(S!�gnature) VECEIVED BY(Signature) DATE TIME <br /> 4q <br /> RELINOUI ED BY(Signature) RECEIVED BY(Signet / DAT TIME <br /> RELINQUISHED BY(Signature) RECEIVED AT LAB 8 (Signature) DATE TIME <br /> RELINQUISHED FROM LAB BY(Signature) RECEIVED BY(Signature) DATE TIME <br /> ANALYSIS REQUEST <br /> SAMPLE ID NO. SAMPLE DESCRIPTION DATE/TIME ANALYSIS REQUESTED SAMPLE CONDITION <br /> SAMPLED UPON RECEIPT <br /> (,(.� - - ,L. - c .2? �' .•-`r`1•. ,,.,' � /sly+a, �J� �' � r <br /> ti 510 <br /> 1 L. <br /> - <br /> ,ti w /53 yl - <br /> 1 <br /> SPECIAL INSTRUCTIONS.COMMENTS. - <br /> lo�ib dIC1 PIC,C.e vU I e ' 5c� <br /> Ck �(�✓.� a 7 �l> �V eVlo4A <br /> NOTE: UNUSED PORTIONS OF NON-AQUEOUS SAMPLES WILL BE RETURNED TO CLIENT. <br /> EXPECTED Immediate <br /> ANALYTICAL Attention (200% Surcharge) RUSH (50-100% Surcharge) Standard <br /> T.A.T.'S <br /> ENSECO EAST LOG NUMBER (lab use only) <br /> ENS-1045-8 <br /> Client Retains White Copy Only <br />