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Vj II m RAW , lm• m m m m � N •_ <br /> U CHAIN OFCUSTODYRE t D <br /> CUSTOMER INFORMATION PROJECT INFORMATION -0 <br /> COMPANI�j: PROJECT NA7NUMBER,' t �� <br /> SEND R! RT TO 1 +' J� cc co <br /> ADDS LII BILLING INFORMATION LU �y <br /> ao0stil b� of !^ BILL TO `��� �r C�` �Z- �y��4, l <br /> ADDRESS 0 <br /> ,�, �_ LAB JOB NO. <br /> Lg <br /> PHON PHONE <br /> t1JI/ <br /> !f f� <br /> FAX �N �.`// FAX PO NO <br /> DAESEE ICONTAINER PRSERVSAnPLENO SAn�LE DESCRIPTION ATEMARX REMARKS 1 PRECAUTIONS <br /> Z P`'(Pi _'� -9,-acv <br /> 4 VvWj "s A <br /> L `S 3 vl <br /> W <br /> cr <br /> Era <br /> x <br /> ¢ SAMPLER SHIPMENT METHOD AIRSILL NO <br /> cr <br /> rn <br /> UJI REQUIRED TURN R ND* ❑ SAME DAY ❑ 24 HOURS ❑ 48 HOURS ❑ 72 HOURS ❑5 DAYS 10 DAYS ❑ ROUTINE OTHER / <br /> 1 RELINQUISHED Y I DATE 2 RELINQUISHED BY DATE 3 RELINQUISHED BY DATE <br /> SIGNATURE SIGNATURE 1{ L,r �r ! r.� (� SIGNATURE <br /> PRINTED NAME/COAN TIME PRINTED NAMEICOMPANY J I I / TIME PRINTED NAME/COMPANY TIME <br /> O /�,rL�li1 <br /> z 1 RECEIVED BY DATE 2 RECEIVED BY DATE 3 RECEIVED BY DATE <br /> SIGNATU ;rr� SIGNATURE SIGNATURE <br /> x I <br /> PRINTED NAM OMPY t �� TIME PRINTED NAMEICOMPANY TIME PRINTED NAME/COMPANY TIME <br /> r!l e7 a <br /> ❑ Amhatm CA ❑ Atlrors 00 ❑ Casper Wy 0 Corpus Chrlsil TX <br /> 1250 E Gena Autry Way 10703 E Bethany Drive 420 W Finn Sues! 1733 N Palle Island Drive <br /> Anaha'm CA 92805 Aurora CO 60014 Casper WY 62601 Corpus Christ TX 76408 <br /> (71 a)937 1094 Fax(714)937 1170 (303)751 1780 Fax 1"751 1784 {307}235 5741 Fax(307)266 1676 (361)289 2673 Fax(3611289 2471 <br /> ❑ Houston Tk(E" ❑ Houston TX(Pel) ❑ Lake Charles LA CI Valparaiso,IN <br /> 6310 Rolhrrey Orale 8210 Mosley Road 3645 Begks Parkway 2400 Cumberland Drive <br /> 70 <br /> Houston TX 740 Houston TX 77075 Sulphur LA 70663 Valparaiso 1N 46383 <br /> (7131 690-4444 Fax(713)690-5646 (713)943 9776 Fax(713)943 3846 (318)583 4926 Fox,318)5834929 (219)464 2389 Fax(219)462 2953 <br />