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'"~-= . ~ Specialty Analytical <br />~ ~~~ 19761 S.W. 95th Place <br />~Y Tualatin, OR 970G2 <br />--~! ~+/~~~ (503) 612-9007 - Phone <br />:--_ ~'~ <br />~ - (503) 612-8572 - fax <br />CHAIN OF CUSTODY RECORD PagP / of~ <br />~ ~ - <br />~ .,ontact Person/Project Manager ~~ ~ ~ CCl (, ~ %/~~ ~ ~ <br />Company ~~' ^v"J~rC G~J~~` ~'~/>~~'~~ti.' ; ~ ~cY~'i-~ <br />-~-- <br />Address ~"'l _5 lV~ 1~((~C.! /~.~"J~(r~t+. S:~~ic ~1Zj_ <br />Collected By: '~ <br />Signature "'~ <br />Printed ~~~ y''~ ~~ ~~''~L\ <br />i <br />Phone C S~7J~3 ) L3l G~ 7 Y Fax ~S`Ly~ L3 %"G~~ ? <br />Project No. d~E; c:c' ~' Z) Project Name Gdc~' f~t/~~' s~ c,t~ .'~.- <br />Invoice To C~.L' ~~-- P.O. No. <br /> For Laboratory Use <br />Sl9natUfe <br />Printed <br /> <br /> <br />Turn Around Time <br /> <br />O Nortnal ~~ ~~ <br />•'~tush <br />~ S eci <br />P fY <br /> <br />Rush Analyses Must Be Scheduled wth The Lab In Advance <br /> <br />~ <br />~ <br />~ <br />:n <br />U <br /> <br />~ <br /> <br />~ <br />Z <br /> <br /> <br />Q <br /> <br />~ <br />~ <br />~ J <br />-~ <br /> <br />? <br />~+ <br />Z Lab Job No. ~~ C E ° <br /> <br />Shipped Via <br />Air Bill No. <br /> <br /> <br /> <br />emperature On Receipt °C <br />Specialty Analytical Containers? Y/ N <br /> <br />S ecialt Anal tical Tri Blanks? Y/ N <br />P Y Y P <br />Date Time Sam le I.D. Matrix Comments Lab I D. <br />~1~~1 yY t3z~~ '~~~-/ ~ ~ X ; <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> ; <br /> <br />e.° L. <br />Relinquished B~ `` ~ ~ <br />Company: ~`Cr~> <br />ate <br />~~l~f <br />Time <br />~ ~Zd <br />Received By: <br />Company: <br />Relinquished By: <br />Company: <br />Date <br />Time <br />Unbss ReGaimed, Samples Will Be Disposed of 60 Days After Receipt. <br />Copiea: White-0riyinal Yellow-Project File Pink-Customer Copy R ived Fo Lab F ate Time <br />~^~~ <br />. <br />~ ~ <br />