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CHAIN OF CUSTODY RECORD Page.~.of ~ <br />/~'" ~~ Specialty Analytical <br />I~~I ~Y 19761 S.W. 9Sth Place <br />Y~- Tualatin, OR 97062 <br />-:~ ~-~ (503) 612-9007 - Phone <br />- = (503) 612-8572 - F~vc <br />. <br />Collected By: ~ <br />Signature ~'~ ~ ` <br />Printed ~" ' <br />Contact Person/Project Manager ~~ ~ ~~~L~L ~I`~i ~, <br />~ <br />Company ' iJs = rl~~' f~. ~t~ /N.~7rT? 1N' ;•. <br />Address ~z-~ /~ ~lt,lC'T/~~'-~'lb~t~ ~d ~TC `f? S <br />~~ f~-7L->}i..~ t) , G3~ . rl 7 Z~ i- <br />PhoneLS`D .~~ 'L31 '1~r1'7~ Fax ~~i~ ~-3 1 -~s ~~~ <br />Project No. C~C~ f~tl d~Project Name ~~,;,~!' ~~,,.fti~ .S4~cX;~`~~ <br />r- T <br />Invoice To ~C<; ~ ~ P.O. No. <br />Si <br />natu~e For Laborato Use <br />g <br />Printed <br /> <br />Turn Around Time <br /> <br />O Nortnal <br />e+a$Qsh ~~' <br />Speciy <br /> <br />Ruah Analyses Must Be Seheduled wth The Lab In Advance <br />N <br />~ <br />c <br />ta <br />c <br />U <br />~ <br /> <br />Z <br /> <br /> <br /> <br />+ <br /> <br /> <br />~ <br />1~.. <br />~ <br />~~ <br /> <br /> <br /> <br />. <br /> <br /> <br /> <br />~ <br /> <br />~ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />~ <br /> <br /> <br />~ <br /> <br />~ <br />~ <br />~ <br /> <br />~ <br />`~ Lab Job No. '~ ~ ~ ) <br />Shipped Via <br /> <br />Air Bill No. <br /> <br /> <br />Temperature On Receipt °C <br />Specialty Analytical Containers? Y I N <br /> <br />Specialty Analytical Trip Blanks? Y/ N <br /> <br />Date <br />Time <br />Sam le I.D. <br />Matrix + <br />.2 <br />Comments <br />Lab I.D. <br />~ ~ 1~ ~t~. - 2 ~ ~~, ~~ ' Nvp.wwr - Tij°~ ~ <br />~ ~~ Y..~ ~"`y°/y~~ <br />IU~ ~'-til~t~ l 14r~' <br />~ <br /> <br />~ ~ ~ a --i-,~3s~ ~~~ ,~ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Rellnquished By: <br />~~„pa~y: ` ~Zr Qate <br />5~b1 f~ Time <br />~~p,' J Received By: <br />Company: Relinquished By: <br />Company: Date Time <br />Unless Redairnsd, Samples IMII Be Disposed ot 60 Days ARer Receipt. <br />Copiss: 1M~ite-Odpinal Yellow-Projsd Fib Pink-Customer Copy Re ed For Lab By: a Time <br />~ <br />~ <br />~ <br />~ U <br />u <br />) <br />