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--~ <br />Signatu <br />Printed. <br />Specialty Analytical <br />19761 S.W. 95th Place <br />Tualatin, OR 97062 <br />(503) 612-9007 - Phone <br />(503) G12-8572 - Fax <br />~ontact Person/Pro~ect Manager ~-C. / ~, S <br />Company L: ~1~1'TV~j G.J'~~~~ ~A.1~1 /Il~'~~Iit~'~~ rJ~(~-i~'~ <br />Address 0~~~ ~Z: ~'~i~l~.r/V~v+~'l~, .5~;`~ ~2..~ <br />~6d-7'c. ~ n d/~' , ~(7L ~ L- <br />PhoneCS~3~ Z 31 • t1 ~ Fax (~j~~ Z~(~(ey~i~, <br />Project No. y~~C~~ Uc7 J 2 7 Y~U ~oject Name CQ~ r'~'~1v~S-~ S. ~~ <br />Invoice To P.O. No. <br />Signatu~e For Laborato Use <br />Printed Lab Job No <br />~ lL~S ~ <br /> <br />Turn Around Time <br />~ormai <br /> <br />^ f~ush <br />Specify <br />Rush Analyses Must Be Scheduled With The Lab In Advance N <br />c <br />~ <br />0 <br />U <br />o <br />~ <br />Z <br /> <br />'\ <br /> <br />~ <br />~ <br /> <br />_~ . <br />Shipped Via C~ 1 F, (~ ~ <br />Air Bill No. <br /> <br />Temperature On Receipt ~ °C <br />Specialty Analytical Containers? ~N <br />~ <br />Specialty Analytical Trip Blanks . Y/ N <br /> ~ <br />Date <br />7~ Time <br />~ Sample I.D. <br />S / L - ~, -- ~. S Matrix <br />~~~ ~ Comments Lab I.D. <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Relinquished By: <br />Company: ~GJ~7.~ pate <br />~~Z~ ~~(~' Time <br />~70~~ Received By: <br />Company: Relinquished By: <br />Company: Date Time <br />Unless Reclaimed, Samples wll Be Disposed of 60 Days ARer Receipt. <br />Copies: White-0riginal Yellow-Projed File Pink-Customer Copy Re ived For La <br />~ at Time <br />~~: <br />- V <br />CHAIN OF CUSTODY RECORD Paoe j of! <br />~.~ i C (~t1 r - <br />