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7 <br /> ERNATIONAL ANALYSIS UEST AND Reference ' a <br /> TECHNOLOGY * Doe x 3 3 3 5 7 <br /> CORPORATION CHAIN OF CUSTODY RECORD Page 1 of <br /> Project Name/No 1 Samples Shipment Date 7 511-f 11& Bill to 5 T C aAvx4 e <br /> Sample Team Members 2 )ZID Lab Destination 8 S fact.+-D-e f J 3 `( ksel k,r 5� , [� 21 <br /> Profit Center No 3 Lab ContactsS � `` <br /> Project Manager �pe Qk iM��� Project Contact/Phone 1271Qw+�36( �3 <br /> Purchase Order Noe -'(v-1 q`i S i3 Report to i0 sti wte ops <br /> f Carrier/Waybill No <br /> Required Report Date �i <br /> Sample s`i Sample #5 Date/Time 16 Container1 r Samples Pre- 19 Requested Testing 20 Conditton on 21 Disposal 22_ <br /> Number Description/Type Collected Type Volume seruatiue pro ram Recei t Record No <br /> rV1w -I �1 Qi. <br /> — s <br /> 3 00 <br /> Ilk to I LAI flo Q <br /> e , <br /> Special Instructions 23 <br /> Possible Hazard Identification 24 Sample Disposal 25 <br /> Non-hazard J Flammable 1_j Skin Irritant J Poison 8 1_ Unknown T Return to Client I J Disposal by Lab Archive Amos } <br /> Turnaround Time Required 26 QC Level 27 <br /> Normal Rush „J ���-`� (o # 1_J ll IJ III i J Project Specific (s ecf ),_ _ <br /> 1 Relinquished by 2 Date T711--16 1 Received b Q <br /> (Sig�setwe/AfSuauwil /' .� y 28 / !L% l - — Date �f <br /> / t-U Time #SigntsturelAflikiappnl Time <br /> 2 fielinquisl�ed by Date 2 Received b <br /> ('AV iu a/AfiihiYl IUB i) Y Date <br /> TimeiS�gn ium�/Aflilmium�) T#I ne <br /> 3 Relinquished by Date 3 Received by Date <br /> (Signature/Afiohauoni <br /> Time (Signatui a/Afhhati mil Time <br /> Comments 29 <br /> WA fns 91 <br />