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'MOOR <br />ANALYTICAL CHEMISTRY DIVISION <br />CALIFORNIA ELAP CERTIFICATION N 1371 <br />CHAIN OF CUSTODINALYSIS REQUEST <br />2527 FRESNO STREET • FRESNO, CA 93 21 • PHONE (559) 268-7021 • FAX: (559) 268.07JO <br />WORK ORDER, <br />#: <br />PAGE---- GF--- <br />ATTENTION: <br />ATTENTION: <br />L3STANDARD FORMAT <br />James DiCarlo <br />MAIN <br />❑ WRITE -ON (STATE FORM) <br />NAME: <br />NAME: <br />Fleetwash <br />O GEOTRACKER/COELT(LEFT) <br />❑ PDF ❑ SPREADSHEET <br />ADDRESS: <br />ADDRESS: <br />1162-1 Bessemer Ave. <br />❑ County DHS : <br />Manteca, CA 95337----------------------------- <br />❑ Environmental Health Agency: <br />PHONE: <br />PHONE: <br />(209) 823-8775 <br />----------------------------- <br />❑ OTHER: <br />FAX: <br />FAX: <br />(209) 823-8574 <br />---------------------------------- <br />SAMPLE INFORMATION <br />SAMPLE TYPES: <br />PRO ECT INFORMATION <br />SAMPLED BY (PR Nn <br />SOLID: <br />CONTRACT/P.O. NO,: <br />BS - BIOSOLID <br />CR - CERAMIC <br />SIGNA E <br />PROJECT: <br />SL - SOIL/SOLID <br />Fleetwash —Manteca Facility <br />❑ PUBLIC SYST M dO T <br />RINE <br />LIQUID,. <br />DW -DRINKING WATER <br />PROJECT NUMBER: <br />El PRIVATE WEL ❑ REPEAT <br />GW -GROUNDWATER <br />PROJECT MANAGER: <br />❑ OTHER ❑ REPLACEMENT <br />OL - OIL <br />Daniel Carlton <br />TURN AROUND TIME: n RUSH, DUE ON: <br />SF - SURFACE WATER <br />n STANDARDST <br />- STORM WATER <br />ANALYSIS REQUESTED <br />"""""------- <br />WW - WASTE WATER <br />NOTES ON RECEIVED CONDITION: <br />L <br />❑ CUSTODY SEAL(S) BROKEN <br />❑ SAMPLE(S) DAMAGED <br />A <br />B <br />N ICE ❑AMBIENT TEMP. ❑INCORRECT <br />PRESERVATION <br />8 <br />VVVVVV ��`��`, <br />U <br />a <br />E CLIENT SAMPLE ID <br />DATE TIME TYPE <br />5 <br />Influent <br />0 <br />WW <br />X <br />X <br />X <br />Effluent <br />?In <br />Lim <br />ios4 <br />X <br />X <br />X <br />REPORT TO: ❑INVOICE TO: ❑REPORT COPY TO: REPORTING: <br />COMMENTS/ADDITIONAL INSTRUCTIONS: <br />MAIN <br />Page 5 of 7 <br />