Laserfiche WebLink
CHAIN OF CUSTODY RECORD <br />,~~~ Specialty Analytical <br />~. <br />~ - ~ '. 19761 S.W. 95th Place <br />_ ~' Tualatin, OR 97062 <br />' ~ (503) 612-9007 - Phone <br />~~ (503) 612-8572 - F~vc <br />Collected By: ~ ~ <br />Signature ~' ~` <br />Printed ~' ~ ~ <br />Page~of~, <br />Contact PersonlProject Manager ~~ r< <~LL ~~tJj <br />Company ~~~ N i t//1 ~ Gi'Ef ~ E~~~ti'~:L iZ-t n,ic'.~ . fC~2P. <br />Address ~Z S~ N~ n'-clG7,tJo~+.t ~ E(~ Sv~ ~ E ~1 L,~ <br />l~u'/Z-r4,~~-~vl> ~Jv~, ~ 7 Z ~ ~ <br />Phone (~st 5~ 2 31- ~~' 7 3' Fax ~Sv'' 'L ~3 i-~- Y 8 2- <br />Project No. ~~~`~'~~~ ~~ Project Name ~ ~~vr'f-~~G J S~ Sy ~.~~~ v~ <br />Invoice To P.O. No. <br /> For Laborato. Use <br />Signature <br />Printed <br /> <br /> <br />Turn Around Time <br />O Nortnal <br />~ush ~y ~ ~- <br />Specify <br /> <br />Rush A~alyses Must Bs Scheduted With The Lab In Advance <br /> <br />N <br />~ <br />~ <br />c <br />U <br />o <br />Z <br /> <br /> <br />n <br /> <br />'~'~ <br />~ <br />~ <br />~ <br />~ <br />~> <br />Lab Job No. <br />Shipped Via ~ ~ E:~'~ r' <br />Air Bill No. <br /> <br /> <br />Temperature On Receipt °C <br />Specialty Analytical Containers? Y/ N <br />Specialty Analytical Trip Blanks? Y/ N <br />Date Time Sam le I.D. Matrix Comments Lab I.D. <br />~i y~ c i~ ~ . r o,' ~ ~ <br /> 1 S~~ <br />~J u 'i - rL <br />~u ~ ~r- +~ <br />3 <br /> <br /> <br />~ <br /> <br /> <br /> <br /> <br /> <br /> <br />Relinquished By: <br />Company: G~l~~~- - te <br />L~ s~ Time <br />r73~ Received By: <br />Company: Relinquished By: <br />Company: Date Time <br />Unkss Reclairtbd, Samples Wilt Be Diaposed of 60 Days ARer Receipt. <br /> <br />Copiss: WhRe-Oripinal Yellow-Projed File Pink-Customer Copy ceived For La y pat <br />/ <br />~5 r Time <br />1 <br />/~. <br />~ <br />~ <br />~ V <br />~ <br />