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CHAIN 0~ ~'~ TODY RECORD <br />-%~ --'~~~ Speci~lty AnaIytic~l <br />~ ( -~ ~ ~'~ - ~, 19761 S.W. 95th f'lace <br />~=~'~''::= i' Tualatin, OR 970G2 <br />- !~ :r <br />i <br />`----- ~ (503) 612-9007 - f'hone <br />(503) 612-8572 - F<vc <br />~ <br />Coilected By: I"~ ~ J <br />.1 ` ~ '1^i~l`~li ~/ <br />Signature <br />Printed ~ "' ~' r`~~ r1-f1- .5 ~`~` 1 <br />Contact PersoNProject Manager ~~ C. _C•C1(.~--I '(`~ ~ <br />~ ' <br />~_ar.~ - <br />Company L~.1.1' i l: ~iZ~/ YJ ~~7J 7= f ~~ i 1~G~~~ ~~CST~~±._~_ <br />Address ~~~ N~ lV\vl(~T NC:+~'~li%1~-( .(J~ ~~I 2.~- <br />~v'' 7L;~-r~b : ~~ ~L~7 2'~'= <br />Phone { ~'~l%~s ) ~~= ~'~ 1 ~~ 0 %~?~ Fax ~~ / 5 ~ ~ ?/ _~~ ~/~~:' . <br />Project No.ll~' ~~'L~P~ ~L~~~~-{~U_Project Name (~~:;_~'~~~~`~~~ Sr,•~,e?~2-! <br />Invoice To <br />P.O. ~'o. <br />Signature For Laboratory Usc <br />Printed Lab Job No <br />'- ~!~~ L~;T• <br /> <br /> <br /> <br />urn Around Time <br /> <br />^ Normat <br /> <br />~Rush <br />Specify <br />Rush Analyses tAust E3e Scheduled wth The Lab In Advance <br /> <br />` <br />~ <br />.~ <br />~ <br />a <br />U <br />o <br />z <br /> <br /> <br />^ <br /> <br /> <br />~ <br />: <br />~ <br />:) <br />.~ ~, <br /> <br /> <br /> <br /> <br />k <br /> <br /> <br /> <br />~ <br />~ ' <br />~ . <br />~ <br />~ <br />Shipped Via~c ' ~ '' J <br />Air Bili No. ~ ~~~~~--~ <br /> <br /> <br />Temperature On Receipt _ ~ °C <br />Specialty Analylical Container;? ~yN <br />Specialty Analytical Trip Blan,s~ ~'-~-t~ <br />Date Tim^ Sample I.D. Matrix ,~ Comments Lab I D <br />y' ~ D ~t ' ! ~~-{ l~ ~ i' LV ~.i ~v cl tt~ ~ ,( <br /> ~I~~ i~~~ 1 S' 'X ~"~ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> ' C ~I' I V L'N ~ - ~., ( <br /> ,ke{!n- ~ 11-~.^~ <br /> <br />~ i <br />Relinquished By: ~ ~~'w`~" ~~1' <br /> <br /> <br />Company: ' -- ~; -~ <br />qate <br />~ <br /> <br />~ ju ~-y <br />Time <br /> <br /> <br />j ~ I L' <br />Received ay: <br /> <br /> <br />Company: <br />Relin uished B <br /> <br />q Y~ <br />Company: <br /> <br /> <br />atc <br /> <br /> <br />ime <br />Unless Reclaimed, Samples Will E3e Disposed of 60 Days After Receipt. <br />Copies: Whitc-Ori;inal Ycllow-Projecl File Pink-Customer Copy Received F ' y. ' <br />~,/ ~~~ Da~r~. <br />(,~. (' ~~ Time <br />'~~^ <br />