Laserfiche WebLink
� r rr r <br /> rloNAr. ANALYSIS REQ AND Referenciocument o 51 <br /> ® C O OGY <br /> M CHAIN OF CUSTODY RECORD* Page a of � <br /> CORPORATION � <br /> Project Name/No i7�• tea-`_!`�9 L _ Samples Shipment Date 7— —9Z_ B[II to 5 CO2 <br /> Sample Team Members__ _ __ Lab Destination — - - o <br /> Ml ArZT t k3eZ f Cly- --- �, <br /> Profit Center No 3 _ SL-!_I __ _ _ Lab Contact N' u� <br /> Project Manager4 �? �i�F3��+ _ Project Contact/Phone 12� aw,?Q1 Report to io <br /> Purchase Order Nos Carrier/Waybill Na 13 ------m <br /> Required Report Date r= <br /> • ■ <br /> m <br /> rn <br /> Sample i 4 Sample i 5 antalruns i e Containers Sampla i Prd• 19 Requested Testing 2U Condition on 21 p pal 22 <br /> Number Collected T Volume servatire Program Remyt Record No. <br /> d3. Z�`9W C�r41'�Q -9Z 1X04 VO4 yOML tlu_ (0 ea� <br /> UH <br /> p\tL , <br /> CL <br /> O <br /> o4ew <br /> d <br /> b <br /> i� V U) <br /> yC M <br /> Q <br /> Q <br /> n <br /> x <br /> 0 <br /> Special Instructions 23 3 <br /> Possible Hazard Identification 24 Sample Disposal 25 ° <br /> Non-hazard L=_�— Flammable Skin Irritant EJ Polson 8 Unknown Return to Client Disposal by Lab Archive _ _ (mos ) o <br /> n <br /> Turnaround Time Required 26 DC Level 27 ca <br /> NormalJ-J' Rushj 1�— II IJ III Project Specific (s ec ) - _ _ _ 5 <br /> 1 Relinquished by 26 Date _ -3i-4 Z_ 1 Received by 28 Date _ <br /> (Signature/Affihahan) 1 , Time [S#gnawre/Affihauon) Time 0 <br /> 0 <br /> 2 Relinquished by Date _ _ 2 Received by Date _ <br /> [Signawre/Affiliabonl Time (9gnawre/Affilmuon) Time <br /> 3 Relinquished by Date _ 3 Received by Date _ <br /> ISgnature/Affiltabon] Time [Signature/Affihation) Time <br /> Comments 29 <br /> MGA 3115191 <br />