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( <br /> J.R.Simplot Company SEND RESULTS TO ALL PARTIES LISTED BELOW: <br /> P.O.Box 198 <br /> Lathrop,CA 95330 Ryan Mock 209-858-6412 <br /> 2095$-2511 <br /> Ryan.Mock@SiMPlotcom <br /> Project ID NA Project Wash Rack—Sump—CUPA Waste Characterization Sample <br /> Name: ` <br /> Remarks: S <br /> COLLECTED BY. Ryan Mock <br /> SPECIAL �:I. <br /> INSTRUCTIONS: 48 Hour <br /> (N�p CAM 17-TTLC TURNAROUND <br /> ANALYSIS �„�8 Metal TCLP TIME <br /> REQUESTED STLC lDX Only t <br /> {xx) Other,Note above in Special instructions Section <br /> y Sample ID Lab ID Collection Matrix Notes or Sample Map, Etc. <br /> t Date <br /> Sump Liquid Sample 5/26/2011 Liquid <br /> ILI <br /> �. <br /> i R <br /> r .............. <br /> Date <br /> a <br /> Date 5''Z6—!/ Received By. Slime w/I <br /> Relinquished-8q`�� &� <br /> Date Received By: & to <br /> Relinquished By: Time <br /> &jffne <br /> Date Received By: Date <br /> Relinquished By: &T-'"n <br /> &Time <br /> Send Sample To: Enviro-Chem, Inc. Laboratories <br /> 1244 E. Lexington Avenue <br /> Pomona, CA 91766 r <br /> i <br /> Ph: 309-590-5905 ? <br /> Fax: 909-590-5907 i <br /> CA-DHS FLAP Certificate#1555 <br /> CHAIN OF CUSTODY RECORD <br />