Laserfiche WebLink
CHAIN OF CUSTODY RECORD <br />Collected By: <br />S~ecialty Analytical <br />19761 S.W. 95th Place <br />Tualatin, OR 970G2 <br />(503) 612-9007 - Phone <br />(503) 612-85?~2 - Fax <br />Page~of~ <br />Contact Person/Project Manager C~~~' l.~i~ ~. l. I I~r7 <br />Company ~ E1vTuf~~1 ~+'.E3'C ~,NG-r-~"'L~i1VC~s ~,.cl:.~ <br />Address ~ L.~~ tk~t,l.'C~60w~~tt~. ~ u~~. t1 L~ <br />~a~-7~-r~v~~0, r,~. ~ ~1 t3L~ <br />Phone ~ 1 '(c~~ ~i Fax f.~~ ~~~ ~.3 j '- ~r `I ~ ~ <br />Project No. Q'~~G~:r~l7 ~//~'~' Project Name ~~,~r~,:rl~ ~~~~~+:-'r+r`~- <br />Invoice To (~~~~ P.O. No. <br /> For Laborat <br />o Use <br />Signature <br /> <br />Printed <br /> <br /> <br />Turn Around Time <br /> <br />O Nortnal <br />O Rush ~~ ~~~ <br />S~~ <br /> <br />Rush Analyses Must Be Scheduled With The Lab In Advance <br /> <br />~ <br /> <br />~ <br />~ <br />co <br />c <br />U <br />o <br />~ <br />Z <br /> <br /> <br /> <br />~ <br /> <br /> <br /> <br />~ <br /> <br /> <br />'7 <br />~ <br /> <br /> <br /> <br /> <br /> <br />, <br /> <br /> <br /> <br /> <br />~ <br /> <br /> <br /> <br />~ <br /> <br /> <br />~ <br /> <br />~ <br />h- <br />~ <br />~ <br />t ~ <br />' <br />Lab Job No. ) '~ ~ <br />Shipped Via,~ `E',~~ ~`i,~~ C-~ <br />Air Bill No. ~' ~ <br /> <br /> <br /> <br />emperature On Receipt ° <br />Specialty Analytical Containers? ~! N <br />Specialty Analytical Trip Blanks? Y/ N <br />Date Time <br />Sam le I.D. <br />Ma trix <br />~ <br />~ <br />C o m m e n t s <br />L a b I. D. <br />% i; ~s+~ 2 3 -L - ~y ~ ~ ~~ ~ ( <br /> <br /> <br /> <br />5 ~~i~ Z Z-,yj~,. Sa: 1 1 ~ ~ v T <br /> <br />3 _~ . <br />Z2 - ' -1. . .~~ <br />~ <br />~ '' '~'r <br />~ <br /> <br /> <br /> <br /> <br /> <br /> <br />Relinquished By: ~ <br />Company: ~~~ <br />y ate <br />rlJ~Y Time <br />j2 ~ Received By: <br />Company: Relinquished By: <br />Company: Date Time <br />Unkss Redaimsd, SamPbs'•Will Be Disposed of 60 Days Aiter Receipt. <br />Copks: White-O~ipinal Yellow-Projed File Pink-Customer Copy R ivad For Lab By: <br /> <br />~(. <br />.~ ate <br /> <br />T~ Time <br /> <br />~Y ~ <br />~ ~ . ~ <br />