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CH~IN OF C~1 <br />~ <br />,%"~-}-~:~~ Speci~lty An~Iytic~l <br />~ ' ~; ,I~ ~ 19761 S.W. 95th ('lace <br />~ I~- - Tualatin, OR 970G2 <br />v <br />~ (503) 61 2-9007 - Phone <br />\`~'~ <br />`~~ -~~ (503) 61 2-8572 - F~vc <br />Collected By: r~ ~ <br />~.fv~ M`l'Z '---` " <br />Signature <br />Printed ~~ ~~~~~'~ ' ~`"~~ <br />ODY R{ECORD <br />P,~~ '_or~ <br />-El%~L, ~'~%~ , ~ <br />Contact PersonlProject Manager c /!1 _~ <br />Company ~r~-% ~ v'~-y~ ~~~ ~ S j E,T-'G ~,~;~ `T'_1N'~~ f Cc~:~~ <br />C~'L~ s-~ ~~iuL~` -~,~r it, ~ . <br />Address C 1 I~i. ~ ~L ~~-t' ~(Z ~^ <br />~ <br />,~ <br />~c'~~~ ~ ~,/~l~' ~~ C/"~ ~i 7L ' ~ <br />Phone ZS~~) '-~t ~C~U;'y Fax (S~l~~ =~~1 -~•~f~'~_ <br />Project No. Y~~+:='L~~~~~~ Z~~ r`1~~'% Project Name <<~:~: rhe:;~ Sy ~.;~r~ <br />Invoice To ~liG Coil, h~' P.O. No. <br />i Fpr Laboratory Use <br />gnature <br />S <br />Printed Lab Job No. <br /> N Shipped Via ~~ / !i ~~!l.'/ , <br /> <br />Turn Around Time Q7 <br />c <br />. 1 <br />Air E3iIl No. L <br /> <br />^ Normal ~ <br />c ~ <br /> <br /> <br />' ush ~ <br /> <br />U ~ <br />~- <br />~ <br />Temperature On Receipl °~ <br />Specify o ~ Specialty Analytical Containers' N <br /> <br />Rush Analyses Must ~e Schedufed With The Lab In Advance O <br />Z ~' <br />!'- <br />\~ <br />Specialty Analytical Trip E3lanks~ Y/ N <br /> J~ J <br />~~ <br />Date Time Sample I.D. Matrix Comments Lab I.D. <br />,S ~c, ~I 2i.' ~~,, ~ ~ti`'k/_ 5 <br /> I I ti ~; ;- % `' = ~•~ - ~ ~ %~ '~ ` ~ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> ~rr G~~;~~' ~ i'~1- ~ 1 <br /> <br /> <br />I A <br />Relinquished By:. J C~ :•~ ,~v1/ i c~~~ Date Time Received By: Relinquished By: Date Time <br />/ <br />~ <br />~ <br />an <br />: <br />Com ~ <br />~~~ / j~ f f;~ S Company: Company: <br />` <br />J <br />, <br />y <br />, <br />p <br />Unless Reclaimed, Sampies WII E3e Disposed of 60 Days After Receipt. Re ~i,~ed For Lab By:/ <br />/~ <br />~l <br />~ ate Time <br />Coaics~ While-0riginai Yellow-Projed File Pink-Customer Copy ~~/,~ ~./ <br />~ .{ '(~l"~ ~' J,C ~/ <br />/ v~ <br />