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CHAIN OF Cl1STODY RECORD <br />; ~"---- `~ Specialty Analytical <br />~ = ~ ~~~: ~ 19761 S.W. 95th Place <br /> 'Y Tualatin, OR 97062 <br />-_- ~ (503) 612-9007 - Phone <br />~~ " _ (503) G 12-8572 - Fax <br />Collected By: 1 <br />~ r, <br />( ~ <br />. , <br />k <br />~ <br />Signature ~ <br />~ ~ <br />.., <br />b ~~~~' <br />Printed <br />Signature <br />Printed <br />Turn Around Time <br />^ Normai <br />,~~Sn Z~ hr2- - -~-, ~,cL l ~ ~.=,-+- <br />by ~;~•n -f b1L~Y S <br />Specify <br />Rush Analyses Must Be Scheduled wth The Lab In Advance <br />~ <br />N <br />C <br />.~ <br />o ~ <br />U <br />o ~ <br />o ~ <br />Z ., <br />Date Time Sample I.D. Matrix <br />S p~. , ., f - / - i~: . ~ ~ <br />~ tS3~ f`/-~`Y°S ~ 2 <br />s~ws r6-~ r5~-~~~~~-..,_JZ,S Is~~ <br />Relinquished 8y: `~''e ~~~ v~~~_ ate Time Received By: <br />~S k ~ ~~~ P Y <br />Company: ~~,L~~i:.%~, ~ ) Com an : <br />Unless Reclaimed, Samples Will Be Disposed of 60 Days After Receipt. <br />Copies: White-Original Yellow-Projed File Pink-Customer Copy <br />Pa^a~of~ <br />Contact Person/Project Manager L'~ ~~ ~ ~'ll r!`;'S <br />Company C~t~lr/F1~ l~/GSi ~N~~N~LF/~I,vL~ ~G~P~. <br />Address ~`25` NC /~f ~f L i~tldr-'1!L/~ S/ ri;t% ~~ <br />t <br />r'v/y % ~.f~-NG v~t . 91 ?3 z <br />Phone (~ZS) ?~t -Gv7~ Fax C~z'~~ Z3i -~~i~'Z <br />Project No. `~~''¢~ ~<^~~~Y Project Name !n ~; 1 ~ic~~ S~~ tU~•~>> `~= <br />Invoice To P.O. No. <br />Fo Laboratory Use <br />Lab Job No. ~ C U Z <br />J Shipped Via~1 ~ C. f~'~ <br />~ Air Bill No. <br />~ ~~ ~ <br />Relinquished By: <br />Company: <br />6t~e eived For La <br />Temperature On Receipt °C <br />Specialty Analytical Containers? Y/ N <br />Specialty Analytical Trip Blanks? Y/ N <br />v <br />Comments <br />Lab I.D. <br />. I 2, <br />Date I Time <br />Time <br />r <br />~~-~ <br />