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CHAIN OF CUSTODY RECORD <br />!- ~=~ S~ecialty Analytical <br />~ <br />~ _. 19761 S.W. 95th Place <br />~- <br />" Tualatin, OR 97062 <br />_ ~' (503) 612-9007 - Phone <br />_.. <br />~~ <br />- " (503) 612-8572 - <br />Collected By: <br />Signature r_ <br />Printed ~~G ~ ~' `'~~~ <br />Contact Person/Project Manager <br />Company_ _ GE7l~C (J~~ ( <br />Address ',1i~~C~ ~U <br />~~ <br />Page r of ~ <br />/ <br />yz <br />~ ~-~ U9"J~l~ 6~- `~7a3 L <br />Phone~ ~ 23,'~~? Fax ~.5~3~ ~3r'~+ ~ <br />Project No. Y~~ dC3 ~Z7 4Pf oject Name ~~JQ-?/~~~. ~+ L~jY~ <br />Invoice To ~; ~,~ ~~ P.O. No. <br />Signatufe For Laborato Use <br />Printed <br /> <br />Turn Around Time <br />~lermal <br />'` ~~ <br /> <br />~ <br />~ Rush ,~i~'1 <br />Specify <br />Rush Anal ses Must Be Scheduled wth The Lab In Advance <br />y <br />N <br />c <br />~ <br />c <br />(j <br /> <br />o <br />~ <br />Z <br /> <br /> <br /> <br />~ <br /> <br /> <br /> <br />~ Lab Job No. O/ p <br />Shipped Via U ~ ~~^'~ <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 1 N <br />Date Time Sam le I.D. Matrix Comments Lab I.D. <br />26YP 1wi~ ~'/-/ , '•~ <br /> <br />4 u l~w t~ ~a us79 - - 1. ~p - /L-~M- 2. <br /> I5~'S' usr ~-4 - .v'~ X <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Rslinquished <br />Company: ~~ Date <br />~/l~ Time <br />f ~,~ Received By: <br />Company: Relinquiahed By: <br />Company: Date Time <br />Unkss Reclairt~ed, Sampbs Will Be Disposed of 60 Daya After Receipt. <br />Copies: White-0rginal Yellow-Projed File Pink-Customer Copy ived Fo Laq <br />~ ~L: ate <br />~~., Time <br />j~ f <br />~ <br />~ <br />~-v <br />~ <br />