Laserfiche WebLink
CHAIN OF CUSTODY RECORD <br />~"-~-~ Specialty Analytical <br />~ ~`~ _ , 19761 S.W. 95th Place <br />T~ - Tualatin, OR 97062 <br />_~ ~-.~.'~~-" (503) 61 Z-9007 - Phone <br />= (503) 612-8572 - Fax <br />Collected By: <br />~i9r ~ <br />Signature <br />Printed ~ArSs~~~C'~~'~-'' <br />Contact Person/Project Manager ~-~ L L O~Li <br />Page 1 of • <br />Company ~ENS~fL~ w~~Si ~Nu~~1L="~~i~fZ,~ (ar.~ <br />Address t~2"S~N c lv~ti( C.7n+L1fti~rlt~~ 5~,~+ ~. ~{ZS <br />~~~-^~1~. OfZ 4~t3 L <br />PhonetSC~~'~3l-bc:'1`~ Fax ~Sb~1 ~Z3~'fe~i~7'L <br />Project No. `{~~Se~+~~ ~~~ 1~~UZ- Project Name CU~ "the;J Sr ~.~:.f+~ <br />Invoice To ~~`' 'c ~1 P.O. No. <br />Si <br />t <br />~e For Laborato Use <br />gna <br />u <br />Printed <br />Turn Around Time <br /> <br />~al <br />'~ush ~ ` ~~ ~ <br />Specify <br />Rush Anatyses Must Be Scheduled With The Lab In Advance <br />y <br />~ <br />~ <br />.~ <br />~ <br />U <br />o <br />Z <br /> <br /> <br /> <br />= <br /> <br /> <br />Q- <br /> <br />~ <br /> <br /> <br />' <br /> <br /> <br />~ <br />Z <br />~ <br />..~ <br /> <br /> <br /> <br />~ <br /> <br /> <br /> <br />1 <br />I!n Lab Job No. ~ ~~ ~ <br />Shipped Via <br />Air Bill No. O <br /> <br /> <br />~ <br />Temperature On Receipt °C <br />Specialty Anatytical Containers? Y N <br />Specialty Analytical Trip Blanks? Y/ N <br /> <br />Date <br />Time <br />Sam le I.D. <br />Matrix ~ `-s,~. <br />Comments <br />Lab I.D. <br />sl~~rk~ ~ ~~- -~ .o s~:~ ~ ~~,4~ ~~z <br /> <br />s~ ~ , ~ ~c ~ ~ ~~ ~:, i~ "u~ , s:. i ~ x x ,~ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Rslinquished ~ '~ <br />Compsny: ~l~ Q~te <br />Si f ~`f Time <br />(~c~ Received By: <br />Company: Relinquished By: <br />Company: Date Time <br />Unlsss Redaimsd, Sampks 1MI1 Be Disposed ot 60 Oaya After Receipt. <br />Coplss: NRiRe-OriDinal Yellow-Projed File Pink-Customer Copy ived Fo Lab B. ate Time <br />~,•Z. <br />~ <br />~ <br />v V <br />~ <br />