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CHAIN OF CUSTODY RECORD <br />Collected By: <br />Specialty Analytical <br />19761 S.W. 95th Place <br />Tualatin, OR 97062 <br />(503) 612-9007 - Phone <br />(503) 612_8572 - Fax <br />~~ ~ C~ ~0 ~ C,1 wj <br />Contact Person/Project Manager <br />Page~of ~ <br />Company ~~"~ t-'4~-~ (ar~3:3 ( ~I~J~IIU~X~G~ , ~~ <br />Address~ ~la'~ 4J~ ~~~/11C~+^~1~6}~ ,Stl~7~ ~7...~ <br />fi~-7~~~; dYz~ `~'72'3 Z <br />Phone `n~ 'Z3i '~Od'~'8 Fax ~5~3~1~~~ -~z{ S'L- <br />Project No.~~ac ed ~2~1 ~( bZproject Name ~~~ ?(,p Sw U~'+^~~"` <br />Invoice To ~' ~J Cz ~C>• P.O. No. <br />Si <br />nature For Laborato Use <br />g <br />Pfinted <br /> <br />Turn Around Time <br /> <br /> <br />i~ormal <br />^ Rush <br />Specify <br />Rush Analyses Must Be Scheduled 1Mth The Lab In Advance <br />~ <br />~ <br />c <br />m <br /> <br />O <br />U <br />o <br />Z <br /> <br /> <br /> <br /> <br />~ <br /> <br /> <br /> <br />V <br /> <br /> <br /> <br /> <br />~ <br /> <br /> <br /> <br />~ <br /> <br />~ <br /> <br /> <br />~ <br /> <br /> <br />~ <br />"1 <br />~ <br />~ <br /> <br /> <br /> <br />~ <br /> <br /> <br />~ <br />M <br />~ <br />J Lab Job No. ~ ~,S <br />Shipped ViaQ ~ P <br /> <br />Air Bill No. <br /> <br /> <br /> <br />emperature On Receipt ~_°C <br />Specialty Analytical Containers? Y/ <br />Specialry Analytical Trip Blanks? 'r/ N <br />Date Time Sam le I.D. Matrix ~ ~ ~ ~ Comments Lab I.D. <br />4 ~30 1 ~ bo ~y ~' ~- ~ 3,~-' ~al° ~ ~ ~ 1~ ~~ c~ e~. N~c. ~~ <br />4130 4 l~t 4~ ~r: __ 3• "` x 7~ Rvw ~~ -~_ Z. <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Relinquished By: ~ aty <br />Compa~y; ~j ~~1 a Ti ~ <br />~135 Received By: <br />Company: Relinquished By: <br />Company: Date Time <br />Unlssa Rec.laaimsd, Samplea Wfll Be Disposed of 60 Days ARer Receipt. <br />Copks: 1Nhite-Oripi~al Yellow-Projed File Pink-Customer Copy ~ived For La at <br />~ Time <br />•~,~ <br />~ <br />~ <br />/ v <br />~ <br />