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CHAIN OF CUSTODY RECORD <br />~ ~-.,~~~ Specialty Analytical <br />~ -,~, 19761 S.W. 95th Place <br />'Y Tualatin, OR 97062 <br />--Y ~' I~' (503) 612-9007 - Phone <br />_-,. ~-~ <br />~_ = (503) G12-8572 - Fax <br />Coliected By: ~ ~ <br />Signature - ~ ~ ~' ~"~`~ <br />Printed I~ r~~~-~ ~~~'~~- <br />~ontact Person/Project Manager ~r~~ C-~y= ~-/i~-' < <br />Paae ~ of ~ <br />Company ~,c N j(ri=`~ ~.t,~~=S % EJL~i /,N~?7~%/L~ . ~.~ <br />Address C~~ ~ 1~.~ ~ rv~uL r/~,ro.+~r1 ~~. S~~f G L/d'i <br />~~ V i="~c. r~-+~+ ~l 0 ~ . i:/.' ~~ <br />Phone C~-~ ll '- 3i --~~c~ ! ~ Fax ~ SZ75 ~ 2 "3 ~ - ~ yty '- <br />Project No.~~~"~~~12 ~"'Project Name Ca.'~' ~t~'Sc' ~~Cl//~° <br />Invoice To P.O. No. <br /> For Laborato Use <br />SI nature <br />9 ~ <br /> Lab Job No. G y L <br />Printed <br /> N Shipped Via <br /> <br />Turn Around Time ~ <br /> <br />. <br />~ Air Bill No. <br /> ~ <br />O Normal ~ ,~ <br />~ <br />~1 o ~ ,~ <br />R <br />i <br />T <br />O <br />°C <br />^ Rush ~~ <br />V~ L U ~ emperature <br />n <br />ece <br />pt ~ <br />Specify o i Specialty Analytical Containers? (!~ N <br /> <br />Rush Analyses Must Be Scheduled With The Lab In Advance ~ <br />Z ~-- Specialty Analytical Trip Blanks? Y/ N <br /> a <br />Date Time Sample I.D. Matrix <br />"~ <br />Comments <br />Lab I.D. <br />9 t~ IJ~ i9- .- It.S So: ~~ <br /> ~C~'~ l k~ 4- 11-~ f Z' <br /> ~Lr~ ~y-5 - tt.~ '~ - <br /> <br />p ~~y5 '7-~f- rt,5~ 5^~ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Relinquished By: ~ ~ ate Time Received By: Relinquished By: Date Time <br />' <br />Company: ~; ..~ [~ ~~y I ~j <br />Y i7L~i~a Company: Company: <br />Unless Reclaimed, Samples Will Be Disposed oi 60 Days After Receipt. ceived Fo ab By: a <br />l Time <br />' <br />' ~ <br />Copies: White-Original Yellow-Project File Pink-Customer Copy ~/ it-K ~ 1-~ ~ <br />% ~ <br />~ <br />~ v <br />