Laserfiche WebLink
'"~ -- ~~ Specialty Analytical <br />~ ;~? - 19761 S.W. 95th Place <br />~T Tualatin, OR 97062 <br />-~.~~' (503) 612-9007 - Phone <br />~_ - (503) G 12-8572 - Fax <br />CHAIN OF CUSTODY RECORD <br />< <br />Paro ~of~ <br />Contact Person/Project Manager ~ l L ~,C~ i~[ _ ~~' j <br />Com an ~~~..- ~ I 1 ' ! ~' i ~ <br />P Y TL- ~~ W~'~ ~ ~~;~ ~ ~ I~ k_ ~ j 1~vC~ , L~'~-~ <br />Address " ~-~- <br />C` ?~~ L~ ~lk t 1 l~t~7' l.,i.H a~ . ~_ i:?~~- ~ i; ~ C <br />L <br />Collected By: ~ <br />Signature ~~~ '~'4 ~" <br />Printed ~~ ~`'u'~ '~ ~-~ <br />Phone__1_571~~ Z~ t -' ~c'~3 Fax_ (S G ~~~ Z ~ \ ~ (e ~ 874 <br />Project No. ~•,c :~ i~ 41 Z~- Project Name C-~;~Y' ~~~;r S~•~.~,y~-_ <br />Invoice To_ ~~~li '~---' P.O. No. <br />Stgnatufe For aborato Use <br />Printed Lab Job No <br />~ `~'L ` <br /> <br />Turn Around Time <br /> <br />O Normal ~~, <br />~sh _~ <br />Specify <br />Rush Analyses Must Be Scheduled wth The Lab In Advance ` <br />c <br />.~ <br />o <br />U <br />o <br />Z <br />~ <br /> <br /> <br />~ <br /> <br />~ <br /> <br /> <br /> <br />-- <br />~` <br />~ . <br />Shipped Via ~ ~ ~ ~O/~ ~~ L{ <br />Air Bill No. ~~ ~; - .~ 5~~~ <br /> <br />Temperature On Receipt ~_°C <br />Specialty Analytical Containers? ~N <br />Speciaity Analytical Trip Blanks? Y/ N <br />Date Time Sample I.D. Matrix ~ Comments Lab I.D. <br />~ ~ ~ ~ ~ ~ ~~ " ~ ~ ~ =,~ ~ ~' ~ ', i~ i~.~ ~~ ~ <br /> _~ /~~ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Relinquished By: :-+~!~"`D'~~ - <br />Company: C ~-~~/ Date <br />'~l~~~C Time <br />/ ~ ~~ Received By: <br />Company: Relinquished By: <br />Company: Date Time <br />Unless ReGaimed, Samples Will Be Disposed ot 60 Days After Receipt. <br />Copies: White-Original Yellow-Projed File Pink-Customer Copy R ived For Lab By: <br />~j~ ~~ -/ ate ~ <br />' 1( ~%1 r~l Time <br />~-f _%~ <br />.J ' - l/ <br />