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i I <br /> h � AmTest Chain of Custody Record <br /> _ c.' l&la 13600 NE 126th PL Suite C r a Ki Iti nd,WA 98034 <br /> I. a o a R e r a a ' e ' Ph(425)885-1664 Fx(425)820-0245 <br /> www.amtestlab.com O <br /> 00 <br /> Chain of Custody No, <br /> Client Name &Address: Invoice To: <br /> GeoDesign,Inc GeoDesign, Inc . <br /> 10700 Meridian Ave North, Suite 402 10700 Meridian Ave North, Suite 402 <br /> Seattle, WA 98133 Seattle, WA 98133 <br /> Contact Person: Benjamin Weinberg Invoice Contact: Lisa Winship <br /> Phone No: 228-239-1.1.53 PO Number: <br /> Fax No: Invoice Ph/Fax: 503-726-3132 <br /> E-mail: beinberg@geodesigninc.com Invoice E-mail: geoaccounting@geodesigninc.com <br /> Report Delivery: (Choose ail that apply) ' Data posted to online.account: YES / NO <br /> Mail / Fax / Email / Posted Online Web Login ID: <br /> Special Instructions: <br /> Requested TAT:.,.(Rush,must.be pre-approved by lab) <br /> Temperature <br /> Standard RUSH ( 5 Day / 3 Day / 48 HR / 24 HR J upon Receipt; <br /> Project Name: Giu6te'Y� f �, Analysis Requested <br /> Project Number: t\J a c <br /> co • c rt . .. a .11J <br /> ul u <br /> AmTest ID Client ID o E c (,1 a cj <br /> (35 characters ritax) o . I-= u 1 a <br /> u o, <br /> i ;32 NvIi•v -1e.,.!.-(..) ir s..3-- d`/ii//(' lsao sc)( f . . . <br /> • <br /> • <br /> Colle / elinquishe y: .'I,:, Date, .. ..lime Recejed By: Date Time <br /> . ,mot✓ /,'7-, r' f <br /> Relinquished By: . Date , Time Re iced By: ✓1 Date Time <br /> .ram" ,f -' 17 //�; 13 i / . ` L' , ~{ h {�j # .r <br /> ,,Rnquished Bv:,-"` Date Time Redelved By: ,i /° Date Time <br /> COMMENTS: • <br /> `i a <br /> P.4 <br />