Laserfiche WebLink
CHAII~ O~ CUST~DDY R~C~RD <br />;__,,. ? ;_~ ~ <br />~" _~ ~' Sreci~lty An~lytic~l <br />~~;_~~ ~;j ~~ 197v 1 S.W. 95th f'lace <br />( ~~F'~;- - Tualatin, OR 97062 <br />1 =~-y~ J <br />~\` - '~~ / (503) 61 2-9007 - f'hone <br />`_,~ (50~) 6 ] 2-8572 - F~c <br />~ <br />Collected By: `~ I <br />~,,~' ~c ~. v' 1~t l ~~~ <br />Signature - <br />Prmted In-'~:;iws~,S= .~~z_',~ <br /> For Laboratory Use <br />Sianalure - <br />J <br />d <br />i <br />l <br />P Lab Job No. ~~~ L~ ~7!J~. <br />- <br />n <br />r <br />e <br />Tum Around Time <br />^ Normal <br />•~Rush ~~` ~~ti~ <br />Specify <br />Rush Analyses Muse Be Scheduled wth The Lab In Advance <br />N <br />v <br />~ <br />clo <br />c <br />U <br />o <br />z <br /> <br /> <br />~ <br /> <br /> <br />~ <br />~- <br />~a <br />~ J <br />~ <br /> <br /> <br /> <br /> <br /> <br />. <br /> <br />~~1 <br /> <br />M I. <br />Shipped Vi~~~~'iV\~=L.Ly1C~~ <br />Air Bili No J <br /> <br /> <br /> <br />emperature On Receipt ~ °C <br />Specialty Analytical Containe•s7 Y/ N <br />Specialty Analytical Trip Bianks? Y! N <br /> <br />Date <br />Time <br />Sample I.D. <br />Matrix ~ <br />Comments <br />Lab ID <br />;r ~ ,y , ~~Y~ ,FF ~ ;. _N ~ ~;^,k,ti- 5 <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> .~ - ~ <br />n - , ,(; <br /> , vl f YL~_. ~ ~/(f.'.' 'ri ; . <br /> <br />Relinquished By. ~"`'"~`''~'~I'~ `~''"`" - <br />Company: L i.` ~ ~, Date <br />7l ~/y~~ Time <br />j ~;,~~ Received By: <br />Company: Relinquished By: <br />Company: Date Time <br />Unless Reclaimed, Samples Will Be Disposed o( 60 Days Afler Receipt. <br />Coaics. White-0riginal Yellow-Project File Pink-Cuslomer Copy Rec ved For Lab B <br />~ ~/f~, f, C~~ ~~a <br />~..~7~` ~ Time <br />~•~~ <br />F'agc /o(~ <br />Contact Person/Projeci Manager ~- 1~ L ~ a 1 ~ 1r~ i <br />Company ~(,l' i ~fl ~ l.~'~~'I G'*)yll~'`Z}'-rWy . C~"~/~-- <br />Address l~ L~~L ~~L"r tiC~r'~1f'fl~, ~c~; 7~ ti 2~ <br />j i•'-T~ ~~~~~ . pr~ .`~ 1 l i Z <br />Phone i5~'S Z~I' ~•~`i~Y Fax ~SC ~> Z il's: `j~'~- <br />Project No. !1-'tT'~: C'~ =~ y1`' ~ Project Name <br />Invoice To ~ ~" '-"C. r P O No. <br />`' .~ ~J ~ <br />