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INTERNATIONAL ANALYSIS REQUEST AND Reference Document No J I U g J d <br /> TECHNOLOGY <br /> CORPORATION CHAIN OF CUSTODY, RECORD* Page 1, of <br /> Project Name/No1 C, F. L l 01(famples Shipment Date 7 r J-' z�. U5 � Bt11 to 5 Z I • C_.�r <br /> Sample Team Members?._ P- fa9 3Lv�_Lab DestinationAc <br /> � <br /> �1A LiT l�1 Cil _ <br /> Profit Center No 3 1$H II Lab Contact 9�o <br /> Project Manager4._S , -n-n, 115 Project Contact/Phone 12 3."a.a, - 3t 4 io ' A S -113Report to ___ _—_L�Lis m <br /> Purchase Order No �"� Carrier/Waybill No 13 s .pk w r 1r by �qb, t <br /> in <br /> Required Report Date-�_ r.At-r,,%@, <br /> Sample 14 ' Sample 15 Date�me 16 Container) Samplel Pre- Requested Testing 20 Condition on 21, Disposal 22 <br /> Number Description/Ilea Collected T e Volume servatava _ P rem Receipt Record No <br /> •ai V r C <br /> 3 <br /> U , -n <br /> J a T a2 <br /> 7 � <br /> ( o <br /> r- <br /> j N '0 <br /> .. [n <br /> '0 <br /> 19'1 M LL),FgA* <br /> o Q <br /> m <br /> -at <br /> LL�we- -a 14 �. <br /> Special Instructions 23 Edo <br /> Possible Hazard Identification 24 Sample Disposal 25 o <br /> Non-hazard Flammable IJ Skin Irritant IJ Polson B fJ Unknown IJ Return to Clientl,J Disposal by Labs Archive _ [mos j m <br /> Turnaround Time Required 26 DC Level 27 <br /> Norma l Rushl_J I fA II IJ III I,J Project Specific (s eci )— <br /> s <br /> 1 Relinquished by 2 Date --I k 3k-g$—_ 1 Received by 28 Date Vii'-�7. <br /> {Signature/Affiliation) Time [Si nature/AffiGaUon r <br /> g ) Time fo. <br /> 2 Relinquished by Date _ 2 Received by Date _ <br /> (Signature/Affifuionj Time (signature/Affiliation) Time <br /> 3 Relinquished by Date 3 Received by Date <br /> (Signature/Affihatton) Time (Signature/Affiliation) <br /> Time <br /> Comments 29 <br />