Laserfiche WebLink
CNAIN OF CUSTODY RECORD <br />/!" -~~ Specialty Analytical <br />( ~ . :. 19761 S.W. 95th Place <br />r - Tualatin, OR 97062 <br />~-~ (503) 612-9007 - Phone <br />~ ~ - (503) 612-8572 - Fax <br />Collected By: ''~ ~ <br />~ ~ ~ <br />Signature '~-",. <br />Printed ti ~ S« <br />Page ~ of ~ <br />Contact Person/Project Manager ~'~ ~` CU:..~ I s/S <br />Company ~~~ rv2~ W'~ST cNy~u~~ Y~r.~~!, ~~"~~~~, <br />Address ~~ S N~ Mt[L7~f d iK~f~. Sd„~ y LS- <br />~~rL f ~.~f-~ ~~ v/~ ~7z 3 i <br />Phone (~~ 3~ ~ 3 l-~~ 1 S' Fax t Sb3~ ~~ 31 ~~~l ~i Z_ <br />Project No. y080 6 ovll 'I Project Name C~t f{~c~~,~ S. ~~~ ~~- <br />Invoice To P.O. No. <br /> For Laborato Use <br />Signature <br /> Lab Job No. ~9 4-3 I 3~ <br />Printed ~ x <br /> Sj <br />~ Shipped Via <br /> <br />Turn Around Time C <br /> <br />. ~ .t u <br />Air Bill No. <br /> <br />O Nortn81 ~ <br />c <br />t-° <br />~ <br />~ <br />6~ush -1 x U ~ <br />t ;,i ..~ Temperature On Receipt °C <br />Specify o -t ~ ~ Specialty Analytical Containers? Y/ N <br /> <br />Rush Analyses Must Be Scheduled With The Lab In Advance <br />Z ~ <br />~- <br />~ <br />~'1 <br />.^ <br /> <br />~ <br />` <br />Specialty Analylical Trip Blanks? Y! N <br /> 3 :j ~ . ~ <br /> ~ ~ ~ ~ <br />Data Time Sam Ie I.D. Matrix ~ Comments Lab I.D. <br />~ ~ u iuu~ u5'~l- ~-iZ.U ' ~~~ ~ •--O I <br /> !0%U ~,jy `l ~ Z~1 Z,L%'• 2 'x ~--OZ. <br /> <br />'IsMIq`~ -3j~ ~~~3 - i - i3.c~" ~ ~C X X N~r-~r -ia-i. -v <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Relinquished By:_ ~~7'~~~t ~~"''~ ate Time Received By: Relinquished By: Date Time <br />Company: l,V'~~ 7 y r(p~~ Company: Company: <br />Unless Redairt~ed, Sampbs Will Be Disposed of 60 Days ARer Recaipt. Received For Lab By: ~ Date Time <br />Copks: 1NhdeAripinal Yellow-Projed Fib Pink-Customer Copy ~ ~,/~.J~.w~ ~ Z5~ ~ '. ~ <br />~ ~ ~ <br />