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Pan- abs (Environmental Chemistry Analysis) <br /> 323 Avenue 10 • Madera, California 93638 • ADivision of <br /> (209) 675-0889 • (800) 846-0008 • FAX (209) 675-0884 Laboratmies,Inc. <br /> 7200 E.ABC IauS Columble,MO 65283 <br /> Tch 31414744579 Pm 314/443.9033 <br /> CHAIN-OF-CUSTODY FORM <br /> RUSII30B 15< CUSTOMER INFORMATION REPORT INFORMATION REQUESTED ANALYSES <br /> - <br /> ABC/Pan-Ag Labs Job/'#l: Customer Name: i Report Attention: <br /> nVAddress: p 3 - Project,P.O. <br /> D.,a Bowed n„LI Ms: City,Slate,Zip: Project Name: _ <br /> - - 'hone: 20 9 S/y/-OC 7 Project Manager: t6j. <br /> rax#: Co To: o <br /> Lab Sample l.D.# Date Time Sampler: Sample Type 3 s V <br /> ...." u..0 No.of � � 'r 'Q • <br /> Sampled Sampled Client Sample Description Location/De th .-o,a., CAnlainers V <br /> SOS-O 3 . 17 -5-- /.t 123 z, s51 <br /> _. !./F r" X u x k <br /> A/df .2�.//r" XX <br /> 3 Sm— STa V X <br /> S - 4e e -2 +Z <br /> urnaround Time: i Comments: ARE SAMPLES: PRESERVATIVE: <br /> Standard Turnaround 7-/ ...� AJ. 7- .2 �' ,( - 7, T. <br /> y �j Ne P TOXIC? NaOH • <br /> (10 Working Days) / Al. FLAMMABLE? H2SO4 <br /> (TPI•/I,1.H TSamples-S Days) - .LAl. -T EXPLOSIVE? HNOI <br /> y� Rush 5 Day HIGH LEVELS? HCI <br /> Rush 3Dayec ASCORBIC ACID <br /> Rush Day r Qe,�L FOR CAM METALS: <br /> Rush Day 0 - V OSTLC El TTLC <br /> _ <br /> Signs' <br /> Date �y Time Printed Name Company Name <br /> Rclinqui.bed By: - /-s�•// S :-rram pm <br /> BeceivedBy: Ay 6 s // /�— �• - =m Gm <br /> Relinquished By: em Pm <br /> Received By: am Pm <br /> Received for Laboratory By: am Pm <br /> PLEASE CALL THE NUMBERS LISTED ABOVE FOR COMMENTS,QUESTIONS,AND QUOTATIONS. THANK YOU FOR YOUR CONTINUED PATRONAGE. <br />