Information
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Conducted on
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Prepared by
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Location
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Start time
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Finish time
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Car Rego
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Sites visited
Customer calls
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Sample collected
- No
- Yes
- X 1
- X 2
- X 3
- X 4
- X 5
- X 6
- X 7
- X 8
- X 9
- X 10
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Photo of samples.
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All samples collected are accounted for and checked by receiving pathology attendant.
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Technician Signature
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Pathology signature