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':; ~: <br />Collected By: <br />Signature~ <br />Printed <br />CHAIN OF CUSTODY RECORD <br />S~eC~G~~~/ AnC~'yt~CG~~ .;ontact Person/Project Man~ <br />~> <br />19761 S.W. 95th Place Company " ~`~ <br />Tualatin, OR 97062 Address ~S <br />(503) 612-9007 -~'hone <br />(5031 61 2-85 72 -~h~x i i' ~t ~-~ r. <br /> <br />Phone_ <br />Project No <br />Invoice To <br />Pa4e i of " <br />~ ,, ~ - <br />~'~ ~~ c__ ~_~~ ~~,., ~ <br />J I~WC[! l, ~~ ~ ~'4.~' ~(~~= <br />'~ ~~2~ 2_ , <br />Fax ~ ~ ~- ~i~~~ g ~ <br />'y~ Project Name _~~ ~ c; c~~ Q,; X~ J~~ <br />d __ _ P.O. No. <br />Si <br />nature <br />For Laborato Use <br />g <br />Printed <br />Turn Around Time <br />Normal <br /> <br /> <br />^ Rush <br />Specify <br /> <br />y <br />Rush Anal ses Must Be Scheduled With The Lab In Advance <br />` <br />c <br />'~ <br />c <br />o <br />U <br />~ <br />~ <br />Z <br /> <br /> <br />~ <br /> <br /> <br /> <br /> <br />"~ <br /> <br />~~u Lab Job Na ~' ~ ~- ~`~'' <br />Shipped Via (,~`L,;~P,v~~ <br />Air Bill No. <br /> <br /> <br /> <br />emperature On Receipt °C <br />Specialty Analytical Containers? Y/ N <br /> <br />Specialty Analytical Trip Blanks? Y/ N <br />at Time Sample I.D. Matrix omments Lab I.D. <br />~ f ~ l-f - 2 ~ ~.0 ` ,S~ ; ( ` <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />, ,~ <br />Relinquished <br />p y <br />Com an : -~ <br />ate <br />"~j T <br />~ '~ <br />Timg ,,, <br />I~7 ~~w <br />Received By: <br />Com an <br />P Y' <br />Relinquished By: <br />Com an <br />P Y' <br />Date <br />Time <br />Unless ReGaimed, Samples Will Be Disposed of 60 Days After Receipt. <br />Copies: White-0riginal Yellow-Projed File Pink-Customer Copy ived For Lab ~ <br />~~, .~ate <br />q~ -' Time <br />f~~ (,~~1 <br />U U <br />