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OLOGY 1111 IS E S1% MAWD^en 1 <br /> N <br /> C ORATION CHAIN OF OUST RECORDS �0f Page 1 of 1 <br /> Project Name/No I F-�Flz-150 -000Samples Shipment date ?_ - 9 y _ Bill to <br /> Sample Team Members 2a I`l q <br /> lib DestinHGion _ _ cC-•�ry�Z <br /> hF��lL'7U�J M 1!�C _ - - - <br /> Profit Center NoLab Contact 9 -- _ _ ------- f I <br /> 1_ _ I to <br /> protect Manager4 Project Contact/Pbo►ie tz5. K <br /> CtZ�S� <br /> � .�Y4 �epart to <br /> Purchase Order No. Z — Carver/Waybill No 13 <br /> Required Report Date-"- _8-4 /--rc?Y <br /> f <br /> Semple 14 9e1►iple 15 oath/Time 16 CI!tal"bri sanipla 4 Ike. 19 it oqueated T660119 20 � Condition on 21 µ Diaposai 22 1 � <br /> Number Deec tiorr/ Collected Type Volume servirliva Pro rats Receipt Aecord No, 3 <br /> AA� F.,I- <br /> C7z�/� -b -A+�rL tr iZ W A 3,t c y q� (G—) S_n' C, <br /> ID <br /> 1 fT <br /> _ <br /> A 10 <br /> I 1 <br /> ecial Instructions. 23 ' <br /> PDSsible HpzqM Identification- 24 Sample Disposal: 25 ' <br /> Non-hazard Jd Flammable Stun irritant IJ poison B l Unknown l.J Return to Client I.J Disposal by Lahld Archwe (mar. I <br /> LN( <br /> arourt Time Required: 26 QC evel:27 <br /> al Rushg ! II III Pra'ect 5 ecrtic (s ea )linquished Date __?-?-4e jf' 1 Received Q'E/Mdle6gn) j5~ by r r r Date I <br /> Time' I�gnewre/amirebont Time' J <br /> 2 Rernquished by Date <br /> 199neulre/afr ,r 2 pecerved by Date ' n <br /> Time (Sigrsedue/Affirlehoh) Time---- -- -- <br /> 3 Relinquished by Date: 3 Received by Date n <br /> (5oneft"/Airinl*nJ ' Time - ----- - - - ---- <br /> q °" Time. A <br /> Comments.29 I •MM. <br /> -' AnPR(1�1A1�: <br />