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~----;, <br />' ---- ~~ Specialty Analytical <br />~ ~~~~ 19761 S.W. 95th Place <br />~ Y Tualatin, OR 97062 <br />_.__ ~.~.,.. <br />-- ~ ~ ~' (503) 612-9007 - Phone <br />~; _ (503) 612-8572 - Fax <br />CNAIN OF CUSTODY RECORD <br />.,ontact Person/Project Mana <br />Company ~C~ f ~ <br />Address ZS ~~ <br />~Z~v=~~ <br />Collected By: ~ <br />Signature ~ <br />Printed ~N~'''~ ~E~`"', <br />Phone ZSL` ~~~ -~ I `~^~' ~ ~ <br />Project No. ~Z` E~~ i Z- <br />Invoice To ~"~ <br />, <br />Page /{ of~ <br />/ _ /~ ~ ~ ~~ ~ ~ <br />er ,s~(~ ~ /l% y <br />6~/~ I- (~ ~.i ~j //l.'C.~.`?= I /~.or L: . % tY~Ln <br />/~lLi.ti'CI~~~~Ll~i~ 5~~~ fr- ~[ Z 5' <br />c~ `7~_~:~ <br />Fax ~~~U~~) L~l ~y~'~ <br />,~/~~' <br />_"F~roject Name ~ ~~1~;~ S-+z S~y L;e{.*= <br />__ P.O. No. <br />Signature For aborato Use <br />Printed Lab Job No. p~ Q~O <br /> <br />Turn Around Time <br />al <br /> <br />^ Rush <br />Specify <br /> <br />Rush Analyses Must Be Scheduled With The Lab In Advance ~ <br />c <br />~ <br />o <br />(~ <br />o <br /> <br />Z <br />^ <br />y, <br />~ <br />~ <br /> <br /> <br />~~ <br />~ <br />~ <br />~•~ <br />I <br />-/- <br />(~.. <br />1- <br />~ Shipped Via ~~ ~ 'EL~~~ <br />Air Bill No. <br /> <br /> <br />Temperature On Receipt °C <br />Specialty Analytical Containers? Y/ N <br /> <br />Specialty Analytical Trip Blanks? Y/ N <br />Date Time Sample I.D. Matrix Comments Lab I D. <br />~314s I~o ~~~ tc~ -4 1~,~,.. <br /> <br />s1~3i45~ e~'3~ (~5"C ~z-- 1-`~~~" ~. <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Relinquished ~ 1.='~ k- <br />Company: ~,,~.~ ate <br />~~~1 f Time <br />(b~y eceived By: <br />Company: Relinquished By: <br />Company: Date Time <br />Unless Reclaimed, Samples Will Be Disposed of 60 Days After Receipt. <br />Copies: White-Original Yellow-Project File Pink-Customer Copy ived For b By: <br />~~ . pate <br />~J~Jc~ ~ Time <br />~~,.'Z~ <br />r `J <br />