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CHAIN OF CUSTODY RECORD <br />~ ~f ~ <br />--~~' Specialty Analytical <br />~` r zr.. r~~ ~ <br />~;;~,I: ~ 19761 S.W. 95th Place <br />~~~- '' ~- - ~ Tualatin, OR 97062 <br />~,.- ~,~' :v. <br />~---=~~~ (503) G 12-9007 - Phone <br />\~-=.~` 1 . (503) G12-8572 - Fax <br />~ <br />Collected By l ~~ <br />Signature ti~ ~`~~'"'L =1r`~ - <br />~^ ~ <br />Printed ~ N ~" ~`ti' ~'~"i <br />Signature <br />Printed---- <br />2~ hn_ <br />Rush Analyses Must Be Scheduled With The Lab In Advance <br />Pagc ~ of_(_ <br />Contact Person/Project Manager ~~~ ~- ~- ~< < ~ ^~ S <br />Company CC~1,1Tb+L1 1r~J ~Sj ~1JC~Ir+'Et~ i^!fa ~ lC'1~~7 <br />Address ~ Z~ N C M~l:: i N'~'~`H ~l'~~ •S•J i•~'_- ~ Z~ <br />~-`:3r~ •~ u~r~'~ ~`'-, f'1 ~3~- <br />- bJ ~ Fax~S~ S~ ~~31 -~'~~~'1___ <br />Phone~,~ ?s^71 ~ 2 3~ 7 f` - -- <br />~ 1 ~ 1 '. C~'..~,~V\C1.,1 SL ~• UC r~C7 <br />Pro ect No.4~ `~'~'< <~ L~ k~ Project Name C <br />Invoice To J~''~' G~~= `'~L- P.O. No. _ <br />