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CHAIN OF CUSTODY RECORD <br />; '~ _=~'~ Specialty Analytical <br />= ~ _;~~ - ~ 197G1 S.W. 95th Place <br />~Y - Tualatin, OR 97062 <br />- ~ ~- (503) 612-9007 - Phone <br />--- ~'J (503) G 12-8572 - Fax <br />Collected By: <br />~ J <br />Signature '~% ~ v <br />Printed ~N'+~~1 ~ 5~ ~^~ <br />.:ontact Person/Project Manager ~~I ~- ~~~ ~ ~- Nj <br />PaqP ~of~ <br />Company ~~.Nr/^ v° I.iJG~..~ CK~Cii r'L~LL 2i~;`~ . Lci'? r, <br />Address ~' ~ ~l,~L~ L~1.(L,T~t.~r'J ~i Vl-l-~ _ ~/, •J-f ~ ~ ! <br />~~c.7 /L i c i~+v '~ . v ~(! `~ ~' S~- <br />Phone C5~ 3) ~ 3~-6~~ ~'y Fax rS~3~ ~~3 i-(~~~t ~-, <br />Project No. `l~" c~~ Z~ ~ ~'~- Project Name ~n~ ~.^_-rti L~~l Sx ~ t i.~+ /-C.~ <br />Invoice To ~~ tL ~~' ~ ~ r~h S P.O. No. ~ <br />nature <br />Si For Laboratory Use <br />g <br />Printed Lab Job No. L~ c~~--[ v T~ _ <br /> y Shipped Via <br />Turn Around Time c <br />ca ~ s,.~ <br />~ Air Bill No. <br /> '" ~ <br />^ Normal ~ <br />> <br />~ ~ <br />~ o ~ !. <br />Tem <br />erature On Recei <br />t °C <br />,~f2ush ~ <br />> <br />" <br />' U '~!~ ~ p <br />p <br />Specify o ~ ~ Specialty Analytical Containers? Y/ N <br /> <br />Rush Analyses Must Be Scheduled With The Lab In Advance <br />Z ~~ <br />~ `~ <br />Specialty Analytical Trip Blanks? Y/ N <br /> ~ \ <br />-rs <br /> <br /> ~ `Z <br />Date Time Sam le I.D. Matrix Comments Lab I.D. <br />~~5 9 IS3::~ -i " Sa:/ ~- <br /> ~ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> / <br />Relinquished By:~ -~. <br />~ I '~ <br />~%`' Date Time Received By: Relinquished By: Date Time <br />, ~ <br />Company: ~" ~' j `„ Company: Company: <br />Unless ReGaimed, Samples Will Be Disposed ot 60 Days After Receipt. ived For Lab B ate. <br />~ <br />~ Time <br />~ <br />Copies: White-Original Yeilow-Projed File Pink-Customer Copy ~ 1~(L~ C(.-~~~ ~ <br />j~ , <br />(J <br /> <br />