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_INSPECTION - C1994082 (70)
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_INSPECTION - C1994082 (70)
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Entry Properties
Last modified
11/9/2020 6:21:57 AM
Creation date
5/8/2008 11:42:39 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1994082
IBM Index Class Name
INSPECTION
Doc Name
Inspection Report
Inspection Date
4/22/2008
Email Name
DTM
Media Type
D
Archive
No
Tags
DRMS Re-OCR
Description:
Signifies Re-OCR Process Performed
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JOHN C. KEPHART_& CO. <br /> GRAND JUNVION [ABORAIURE <br /> 435 NORTH AVENUE • PHONE(970)242.7618 ♦ FAX 243.7235 ♦ GRAND JUNCTION,CdLORAOO 81501 <br /> CHAIN OF CUSTODY FORM <br /> ti tiNNN zzzzzNn.zZZI Nn.N NNIZZI ti I Z nr ti�.nr.t.n.I4 K.ZZ tiIzZZ' ZZ.I Z-Z .IZZ-ZI.n.ZZn.n.h"M tin.1.^r Z Z Z I Z Z <br /> Company Name ( <br /> Contact C 4-1 _ r <br /> Addresst -ej- C2 = µ _ .t-f_t � - - -_-_-_------ <br /> ------------- <br /> Phone number - FAX# <br /> PO#------------------- Project name__---------------____--__------- <br /> Special Requests: <br /> RUSH for extra charges , <br /> FAX when done - give number above B <br /> ( ) CALL when done - give number above ` `' °> <br /> ( ) OTHER <br /> ---------------------------------------------------- .) <br /> ---------------------------------------------------- <br /> USE THIS AREA FOR ONE SAMPLE ONLY: <br /> Sample name: _ _� = � _ <br /> DATE: __-TIME:_ SAMPLER: <br /> CONTAINER(S) : NUMbk R___1 __TYPE_(_JLegr_,Z*_jr PRESERVAT I VE_ <br /> ANALYSIS REQUIRED: <br /> - -- -------------------- ------------ -------- <br /> -- 1 --------- -------------------- -------------------- <br /> c <br /> -------------------- -------------------- -------------------- <br /> ------=------------- -------------------- -------------------- <br /> -------------------- -------------------- -------------------- <br /> USE THIS AREA FOR ONE SAMPLE ONLY- <br /> Sample n me: _ _ Q _- ��-_ ______ <br /> DATE:O'k` _2__ZQ�' __ _TIME:_J�t _-SAMPLER: <br /> CONTAINPR(S) : NUMBE- TYRE f-- _ { . CPRESERVATIVEL___ 1�_z�_ _ gym <br /> ANALYSIS REQUIRED: <br /> _ _ <br /> ------s � � _-- -------------------- -------------------- <br /> -------------------- -------------------- -------------------- r <br /> -------------------- -------------j <br /> - --------7------------ <br /> -------------------- ------------- -------------------- <br /> RELINQUISHED BY SAMPLE (signature)_ <br /> TO (signature> :_ � - -DATE IME - - - - - <br /> _ -.---- <br /> RELINQUISHED BY:_ _ <br /> RECEIVED BY: ------------------=------------DATE, TIME_------------ <br /> RELINQUISHED^BY: <br /> --------------------------------------------------- <br /> RECEIVED BY: _______________________ DATE TIME <br /> RELINQUISHED BY: <br /> RECEIVED BY: ----------------------DATE, TIME............. <br /> NOTES: Signature affirms representation of the organization or person <br /> requesting the analysis, and agreement to the TERMS AND CONDITIONS. <br /> W Special handling may require additional charges. <br /> 28 <br />
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