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CHAIN OF CUSTODY RECORD <br />" "-~-. Y,~ Specialty Analytical <br />~ ~i~~ ~, 19761 S.W. 95th Place <br />`Y Tualatin, OR 97062 <br />~~' (503) 612-9007 - Phone <br />-~'J (503) G 12-8572 - Fax <br />Collected By: Y; <br />Si nature --~-' ~' t y v~~~ '`~a~Lcc~~~ <br />9 <br />Printed ~ 7" ~~ ~"i ~1'~~-~ ~ ~~~ <br />Contact Person/Project Manager ~'~~ ~C r~~'<<-~~`1 <br />Paae l of ~ <br />a <br />Company ~C /.~ j~~iF-' ~> LL~~~~~7~ ~ ~R-~ 4~ /it..'~-~•t,/ ~'L: c~ ; ~:~.~-~ <br />Address ~~~ ~ /~,~ ::' it~~.l~.TjV~ ~%~/'1 tl ~ _~.~ ~_~__~~4' S- <br />-, <br />~'c'-i~=i~Ct~.~L~, %~~~~ `~" 7~? ~ _ <br />, <br />Phone~ <Z~ %: ~ 3/ ~~=• ~7S Fax 1' ~ ~ ' ~ = ?/ ~-; ~=O7 --. <br />Project No. y~'~?C~%U~ Project Name i~~'~rt~~u_~2 ~>~~,~r~? <br />Invoice To <br />P.O. No. <br /> For Laborato Use <br />Signature <br /> <br />Printed <br /> <br /> <br />Turn Around Time <br /> <br />~ Normal <br />~ • ~ <br />~2usn ! `~ N r - <br />Speciiy <br /> <br />Rush Analyses Must Be Scheduled wth The Lab In Advance <br /> <br />~ <br /> <br />~ <br />~ <br />(Q <br />~ <br />V <br /> <br />~ <br />o <br />Z <br /> <br />~ <br />~ <br /> <br />~ <br />~J <br />, ~ <br />;~ .. <br /> <br /> <br />~ <br />~ <br />`~ 3 ~ <br />Lab Job No. ~ ' <br />Shipped Via ~\ 1~-c.'L f <br /> <br />Air Bill No. <br /> <br /> <br /> <br />emperature On Receipt °C <br /> <br />Specialty Analytical Containers? Y/ N <br />Speciaity Analytical Trip Blanks? Y/ N <br /> ~ <br />Date Time Sample I.D. Matrix <br />- ~ <br />` <br />c Comments <br />~ <br />~ <br />7 <br />f Lab I D. <br /> <br />~ ,, , ~ y <br />t~ ,~ - <br />, ~ ~..~ _ ~,i <br />~ ` ~ <br />~ ,~, <br />~ <br />~ <br />C <br />~~ <br />~ <br />, <br />~ <br />% <br />~ <br /> ~ <br />~ . <br />L <br />,% <br />n <br />rt~i~~ - <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> r i <br />~~'~~~"'~~' ~'~ <br />Relinquished By:~~ ~ <br />; i <br />Company: ~~'~ ,~ L, qate <br />~ <br />_~~i :~ ~~ ' <br />i-~ ~,~ Time Received By: <br /> <br />Com an <br />P Y~ Relinquished By: <br /> <br />Company: Date Time <br />Unless Reclaimed, Samples Witl Be Disposed of 60 Days After Receipt. <br />r~~~oe• White-~riainal Yeilow-Project File Pink-Customer Copy ived For La <br />//(y ~ at <br />~'~`" Time <br />~5. ~'~ <br />~ U <br />