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MRMAffl%ATBRlW, 10. <br /> ° CHAIN OF CUSTODY RECORD <br /> USTOMER INFORMATION�;� PROJECT INFORMATION <br /> COMPAN //�r^-�) PR JECTJ�A EINUMBER M a2�?2J$ 173r NG) <br /> SEND REPORT ro�1 I [•� I V , Hyl BILLING INFORMATION I,I z �4-' Y ,T <br /> A!)O�5 BILL TO yQ, <br /> ADO) <br /> ADDRESS V LAB <br /> JOB NO. <br /> cc <br /> PHON A n PHONE c r <br /> FAX /� \` D - FAX PO NO Z <br /> SAr ( J savwLE DESCRIPTION DATE �E x CONTAINER PRESIERV REMARKS 1 PRECAUTIONS <br /> ui 11-0 1 3 x, <br /> roe 3 <br /> ira <br /> z <br /> X0 SAMPLER SHIPMENT METHOD AIRBILL NO <br /> n <br /> r REQUIRED TURNARO D* SAME DAY 24 HOURS F1 48 HOURS 72 HOURS 5 GAYS i 10 DAYS { ROUTINE OTHER <br /> 1 RELINWSHEDBA A DATE 2 RELINQUISHED BY DATE 3 REIJNQUISHEO BY PATE <br /> 'a SIGNATURE SIGNATURE SIGNATURE <br /> s <br /> z PRINTED NAME/COM ANY TIME PRINTED NAMEICOMPANY TIME PRINTED NAMEICOMPANY TIME <br /> z 1 RECEIVED RY DATE 2 RECEIVED BY DATE 3 RECEIVED BY DATE <br /> SIGNATU SIGNATURE SIGNATURE <br /> r <br /> n <br /> = PRINTED N OM NY 1 T)ME b PRINTED NAMEICOMPANY TIME PRINTED NAMEICOMPANY TIME <br /> ❑ Ansh4k ❑ Aww.CO ❑ C..pr wry ❑ Corpus Chdstk Tx ❑ Edison NJ ❑ Houston TX(Env) <br /> 1250 E Gene Autry W.y t07W E Be6ran,Drive X20 Ytl Firs Street 1733 N?aGs Island Oriva 264 Aerilan Center Parkway 6310 Aotlnvay Owe <br /> Ardhom CA 62505 Aumr.,CO BOOL a Clem 4YY 62801 Corpus Christ!TX 78406 Ed440n NJ 06637 Houston TX 77000 <br /> (714)637 1064 Fax 0714)6371170 003)751 1760 Fax(303)751 1784 (307)235-5741 Fa(307)266-1678 <br /> (512)286-2673 Fax(512)286-271 (606)225-0700 Fax(908)2256777 (713)680-U<4 Fax 81316603846 <br /> Q Ha 014 TX(PM} ❑ Indianapolis IN ❑ L.4s Ch&dw LA ❑ Lanp Smack CA ❑Tampa,FL ❑ VelyerslW 1N <br /> 6210�psl�y F(aad 7728 L4dbsr RoW JWS Beth YeAwy 3700 Gwry Avenue 5480 8aetunad Canter 13t d. 2400 cunteAsrld Orale <br /> Flau4n,TX 77075 IniAmn.poWN 46266 $t o L170663 l�o rrgap BasrJt,CA WW7 T�p�.FL 3 74 Valp.raso,IN 46383 <br /> (713)64}6776 Fax(713)643.9646 (317)6753664 Fax(317)672-G166 (316)563.4626 Fats(318)563-4626 8161 5656401 Far(3101427.5174 (8a1SIe64-6 86 Fu(613)885�41�18 (216)464-2386 Fax(211»462 2253 <br />