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CNAIN OF CUSTODY RECORD <br />'""~-: <br />.'~~ Specialty Analytical <br />., <br />~ ; ~ ~ 19761 S.W. 95th Place <br />~~ <br />~ Tualatin, OR 970G2 <br />-~ <br />~- (503) 612-9007 - Phone <br />~, _ (503) 612-8572 - Fax <br />Coliected By: ~, ~~~ ~~, ~ <br />Signature r 1 <br />Printed ~ ~ ~'~'tit ~~'n Sc~ ~~ ` <br />P.O. No. <br /> For Laboratory Use <br />Signature <br />Printed <br /> <br /> <br />Turn Around Time <br /> <br />. ~-Jormal <br />~ <br />^ Rush <br />Specify <br /> <br />Rush Analyses Must Be Scheduled wth The Lab In Advance <br /> <br />~ <br />~ <br /> <br />.~ <br />~ <br />c <br />~j <br />o <br />~ <br />Z <br /> <br /> <br /> <br /> <br />~ <br /> <br /> <br /> <br />J <br /> <br /> <br />'~'_ ,, ~ - ~ <br />Lab Job No. ~ e V>~`~ <br />Shipped Via <br />Air Bill No. <br /> <br /> <br /> <br />emperature On Receipt °C <br /> <br />Specialty Analytical Conlainers? Y/ N <br />Specialty Analytical Trip Blanks? Y/ N <br />Oate Time Sample I.D. Matrix Comments Lab I.D. <br />, <br />3,~'lj ~ (~~iS w5~-~0 C ~ ~ ~ ~ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> %~ <br />Relinquished By. '"~ ~~`~ <br />Company: C'i wC ~ Date <br />3J I~ f ` Time <br />{~ ~ Received By: <br />Company: Relinquished By: <br />Company: Date Time <br />Unless ReGaimed, Samples Will Be Disposed oi 60 Days After Receipt. <br />Cooies: Whito-Original Yellow-Project File Pink-Customer Copy R iv b <br />~ ~, f ~~ Datg <br />~ ( ~y Time <br />~ ~ `~S <br />Paae~of , <br />Contact Person/Project Manager t 2-1C.- (_Cr• c..~ 1~~%S € <br />Company ~,~ ~% i JR ~ 1~% ~~Z 1 ~ ru~t ~'~`~~~~'~~r"G~ ~ ~ c;(~-~ , <br />Address ~`' Z-~ ~~ M'~1~=( Nv~~~N, i~ , 7c ~f Z4 <br />~''vlz~ ~ ~-~'rr~ ~ ~~ `l ~1 Z 3 L <br />Phone ~ ~-2;', ~ ~Z 3t -4~ ~~ ~ Fax ~ ~2 3 ) Z ~j\ - ~ `I ~ L <br />Project No. ~I D~O (~ Oc~ ~ I~ p~oject Name ~.w: ~-~~~-i' ~~- S y~:, ~K- ~=' <br />{, <br />Invoice To <br />