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/J ~~-__ ~-~` ,\~ <br />_-~1..-~II~ Y~- <br />~_ _~~ ~ I <br />-~ <br />~ <br />S~ecialty An~lytic~l <br />19761 S.W. 95th Place <br />Tualatin, OR 97062 <br />(503) 612-9007 - f'hone <br />(503) 612-8572 - Fax <br />CHAfN OF Cl~ rODY RECORD <br />Collected By: ~ ~ <br />Signature ~ ~`''.~~^^i..." J _ ~~u-" ~ <br />Prinled IN~.~~:-~i"- ~~~._;,~--- <br />Contact Person/Project Manager G'~-~ L~. C~l. l: I i~ ~ <br />r~-~ l or~ <br />Company Cl LT1 l V~~~ l~ ~-S ( L-?J ~; ( NcL-~'-I ti'C~i-~,lIT <br />Address_ ~~-~ h-NL K,iC{lTti-'~~.~tlh[h S~S k- ~-1'Z.S <br />~~`~~~ L.~ ~I~~i OY'_, `'( 7L ~ L <br />Phone~~3) L3~'l;,d")`~ Fax ~.S~Di~ 23~~ ~`-i,~-~"? <br />Project No. ~~ :i~~i; 27 ' QLProject Name L~~ ~" ~~~yr ,5,;.: ,•.{)_:Z- <br />invoice To ~~ L~: ~7- P.O. No. <br />Signature <br /> For Laboratory Usc <br />Printed <br />~ <br />~ <br /> <br /> <br /> <br />um Around Time <br /> <br />O Normal <br />1 <br />""g-R~sh Z~` V~1~'-. <br /> <br />Specify <br />Rush Analyses Must Be 5cheduled With The Lab In Advance <br /> <br />` <br />~ <br />~ <br />`° <br />C <br />(j <br /> <br />o <br />~ <br />Z <br /> <br /> <br /> <br /> <br /> <br />l <br />~ <br />~ <br />~~ <br />~~' <br />~ <br />~~ <br /> <br />~ <br /> <br /> <br /> <br /> <br /> <br />~ <br /> <br /> <br /> <br /> <br /> <br /> <br />-_ Lab Job No. <br />~~ <br />~ ~ ~ (~ <br />I <br />Shipped Via~ ~~.-' /~L ; /1 (~,. <br />--c~ : ~ <br />Air ~ili No (=y., ~ -{ ~i ~ =L~ :~ <br />~-"~ <br />~ <br />Temperature On Receipl i °C <br />Specialty Analylical Con;ainers? '~/ N <br />Specialty Analytical Trip Elanks % Y/ N <br /> ~ r <br />Date <br />Y <br />' <br />~ Timc Sample I.D. <br />' <br />~ ~ Matrix Commenls <br />- Lab I.D. <br />2 <br />15 1 ~ 5:; -~r L ~ <br />'1~ yt1%. •k s- 5 <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> ., <br />. ~ <br /> <br /> ;~s~k~ ~Z;3:' .~~- <br /> <br />~~~ <br />Relinquished By:~J ~1'`' ~~~- <br /> <br />Company: ~ ~,`;?~--.. <br />Dale <br /> <br />`~11a'~ !~ <br />Time <br /> <br />l~x% <br />Received B <br />Y <br />Company: <br /> <br />Relinquished By: <br />Company: <br /> <br />Date <br /> <br />Time <br />Unless Reclaimed, Samples Wili Be Disposed of 60 Days After Receipl. <br /> <br />Copics~ White-Originai Yellow-Projed File Pink-Customer Copy e ived For Lab By~ ~ <br /> <br />~/~/~ ~1 c, ~/ ~/ ~, ~ ~ate <br />/ r <br />(~~5~,/~. Time <br /> <br />~ ~~y~f <br /> <br />