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TE it <br /> ATTorrA><. D� 5 ANALYSIS RED ST AND Reference Document 129999 <br /> ��oL� <br /> CORPORATION CHAIN OF CUSTODY RECORD* Page 1 of 1 <br /> Project Name/No. P A Q, V�-t lSamples Shipment Date z .Lo Bill Bill to:6 rk r 2 <br /> Sample Team Members nU Lab D 8 S � '� t° "� - <br /> P , �C estrnation _ _ o <br /> Profit Center No. 3 3 Sy Lab Contact 9 G;I o.K,J _ <br /> __ n <br /> Project Manager4Project Contact/Phone 12._ 102 - S�1'Z- to <br /> — - Report to: <br /> Purchase Order No. 6 Carrier/Waybill No. 13__ r�w +S4- _ <br /> Required Report Date 3 --- -- - - <br /> _. --- m <br /> Sample 14 Sample 15 Onte�me 16 Container) Sampielpre. 19 Requested Testing 20 Condition on 21 Disposal 22 m <br /> Number Desefi tion/T a Collected T e volume servathm Program Rsimlipt Record No. <br /> a .4 , <br /> 0 <br /> V ra .. c <br /> NONN LD <br /> K <br /> In,J 10- `! 3 <br /> v�a J i -,1C[,. BTe i w: a <br /> C <br /> 0 <br /> r <br /> Special Instructions: 23 <br /> Possible Hazard Identification: 24Sample Disposal: 25 <br /> Non-hazard J Flammable 1„J Skin Irritant J Poison B J Unknown 3J Return to ClientDisposal by Lab 1_J Archive - (mos.] n <br /> Turnaround Time Required: 26 QC Level: 27 <br /> Normal J Rush J LIJ Il.J IIIJJ Project Specific (s eci ): <br /> 1. Relinquished by 28 Date: l a+Z5(0 1 . Received by 28 Date:_ W(Z�(9 C <br /> (Srgnsture/AHrliaGonl Time: Qct (Signature/ANilietionl444QTime:- 0C 0 t <br /> c <br /> 2, Relinquished by Date: to I Zu I e-i3 2. Received by Date: (0(2 6 r U <br /> ISignatunr/A1fdwl�urd G Time: c)z a [Signature/Affiliation) <br /> Time: /Of Z o <br /> 3. Relinquished by (� ` ���^ Date: (0(Z v (9 3 3. Received by Date: p zu q3 <br /> (Signewrn/Alldisuon( �. -�--- Time: ;+S (Signetura/Affiiietion( <br /> Time: <br /> Comments:29 <br /> MCA 31i"i <br />