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Pan- abs (Environmental Chemistry Analysis) <br /> 323 WAvenue 10 • Madera, California 93638 ADivisionof ASIE <br /> (209) 675-0889 (800) 846-0008 • FAX (209) 675-0884 laboratories,Inc. <br /> 7200 E.ABC Lane,Columbia,MO 65202 <br /> Tet: 314/4718579 Fac 314/443.9033 <br /> CHAIN-OF-CUSTODY FORM <br /> RUST LJOB :CUSTOMER NINnFORMATION REPORT INFORMATION REQUESTED ANALYSES <br /> ABC/Pan-Ag Lab.Job s: Customer Name: ///!i e G $• a Report Attention: N <br /> Address: O 3 Project,P.O.#: <br /> Dare Entered on LIMS: city.State,Zip: p 2.9AProject Name:'-- x q a <br /> phone: , 0d-/ a � <br /> Project Manager: e 2 A 0 <br /> rax#: Co To: a 'c s aQ 'e <br /> Lab Sample LD.X Dale Time Sampler: Sample Typ< T tJ <br /> sa.n.s uama N,.of `e 14 • <br /> n <br /> Sampled Sampled Client Sample Description Location/De th o.ma.. Containers U <br /> 5- X X <br /> ? <br /> s/ - 3- <br /> /0 :10 <br /> o :eo S—`/ %v3 X <br /> o tye X X <br /> 0 7/ /o : IS S-6 i/ x x <br /> c, S-7 X <br /> a <br /> a <br /> /0: m Pz <br /> O <br /> lo:5o P-9 <br /> /0 : �3 S•/o DP/ — <br /> turnaround Time: Comments: ARE SAMPLES: PRESERVATIVE: <br /> Standard Turnaround / �a, /! A a 3 ~' A .-U-.? TOXIC? NaOH . <br /> (10 Working Days) — FLAMMABLE? 1-12504 <br /> (T`PF_I,,LUFT Samples-S Days) EXPLOSIVE? HNO3 <br /> X Rush 5 Day HIGH LEVELS? HCI <br /> ---fff-'ii— Rush 3Day ASCORBIC ACID <br /> Rush 2 Day FOR CAM METALS: <br /> Rush I Day O STLC a TTLC <br /> a <br /> Signature I Date Time Printed Name Company Name <br /> Relinquished By: •/ 7- 95' r <br /> Received By: L_ / ,� .�J am pm <br /> Relinquished By: am pm <br /> Received By: am Pm <br /> Reeeivad for Laboratory By: •m Pm <br /> PLEASE CALL THE NUMBERS LISTED ABOVE FOR COMMENTS,QUESTIONS,AND QUOTATIONS. THANK YOU FOR YOUR CONTINUED PATRONAGE. <br />