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CHAIN OF CU~TODY RECORD <br />~ <br />%"~ -=. ~.'~ Specialty Analytical <br />; <br />~ ~ ~ ,~ - ~ 19761 S.W. 95th Place <br />1Y Tualatin, OR 970G2 <br />_.~ ~' *~: <br />~-~ (503) 612-9007 - Phone <br />_ (503) 612-8572 - F <br />Collected By: <br />Signature ~~ yy~~Y ~~ ~ <br />Printed ~ ~~~~'~~~ ~ ~~~~'~~ ~'~ ~ <br />Par j of~ <br />Contact Person/Project Manager ~~ ~ ~.[%~l L /~'S <br />Company_~~}+?b'1=1r yV'~ / ~~:~ lK-~~'~%'-{~: ~i~a"-~ <br />, <br />Address ZJ 1~r r= /~l ~L ~!/l.~Gys~vf i~i~-~-. .~~~c ~,.> Ci ).-t~ <br />'Li~-"1 <br />Phone_ <br />Project No. <br />Invoice To <br />~i7L~~y-- <br />F~ <br />Project Name <br />P.O. No. <br />St natufe For Laboratory Use <br />Prn ted <br /> <br /> <br /> <br />urn Around Time <br />^ Normal <br />Rush ,~ ~1' ~~ t~ ~ ~ J L- AN) <br /> <br />~ Specify <br /> <br />y <br />Rush Anal ses Must Be Scheduled With The Lab In Advance <br /> <br />~ <br />~ <br />c <br />~ <br />U <br />w <br />o <br />~ <br />Z <br /> <br /> <br /> <br />r <br /> <br /> <br /> <br />y <br /> <br /> <br />j <br />, J <br />- <br /> <br /> <br />~ <br /> <br /> <br />~ <br /> <br />` <br /> <br />~ <br />~ Lab Job No. q 9~ ~'~ ~~ ~ <br />r 1 <br />Shipped Via ~~ ~ ~t~. {' <br /> <br />Air Biil No. <br /> <br />Temperature On Receipt °C <br /> <br />Specialty Analyticai Containers? Y~/ N <br /> <br />Specialty Analytical Trip Blanks? Y/ N <br /> <br />Date <br />Time <br />Sample I.D. <br />atnx 9 <br /> <br />Comments <br /> <br />Lab I.D. <br />S ~'~( ~ t~ 5 ~ i i Z. ' L"~. ~`~ So, l 7~ 7~ - t~' <br /> 4 ~ 4 r~ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Relinquished B~ (.~ L '~ <br />Company: ~ j„~~~ Date <br />'~~~ I Tim e~ <br />`lyp Received By: <br />Company: Reiinquished By: <br />Company: Date Time <br />Unless ReGaimed, Samples Will Be Disposed of 60 Days After Receipt. <br /> <br />Copies: White-0riginai Yellow-Projecf File Pink-Customer Copy ived For Lab <br />~ pa <br /> <br />~~ Time <br /> <br />(~p r~ <br />- / - v <br />