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www.fglinc.com CHAIN OF CUSTODY <br /> '4NDANALY5ISR6QUESTD0CVME" ORIGINAL <br /> n <br /> Clienr. i-5 e n4er pci 3 27 Sampler(s): $50 Y) <br /> ❑New Customer Customer Number: -75 Rush Analysis(surcharge will apply): <br /> Address: <br /> --J'7490'7490 W 13roa d -a V 05 Day 134 Day 133 Day 132 Day 1324 hour <br /> 5— CL- 00, CA. OAr)2V6 - Rush pre-apPmved by lab: <br /> Comp Sampler Setup Date-_Time,_ Electronic Data Transfer.0yesyes [Ino <br /> Phone: "32�- 80� fax <br /> r1 Qrro con'-7 Tune: Mileage: If s <br /> E-Mail: 7 3 L>�'CC d Y7 yes, State_Client_Other <br /> Project name: Shtp Ing Cha e: Pickup Char e: LLab number. <br /> Contact person: TRStrn I CZ1 3 y <br /> Billing Information(if different from above) <br /> Address: <br /> c? _ ac <br /> l7 pry q Q 1 0 <br /> `o m Sra3 v z <br /> Phot e' Fax <br /> vo m f~ <br /> Contact person: e v = z a = <br /> 5 g O <br /> Purchase order/contracVFGL quote number: .. � 3 i 'V 5 o a z o" <br /> Pre Log Required:yes_ Frequent -Month{yo weddva Qt,anerlyt7 € c g a 3 �+ 09 d x '� <br /> 'y Ctherf7 u t 3 m ,_ m r I <br /> v 9 ^ 3 m <br /> mum <br /> c° a n N = > vrg <br /> J % I <br /> is <br /> @ � g <br /> Numpber Loca[Ion/Desviptfon 5pled Sampled Z 9`5Z ^o. 3 vl V <br /> a <br /> 0 <br /> aeym:bra br aqb ou<a<,m.,.d q.amwee rN .nu.avnmeeu <br /> a,�: z L TIa: o�w aamymm.an: u, . <br /> L11 <br /> dqc. mm�� <br /> a w w: 9.tr. oZ 1W nm.: r7' �t7 <br /> trm.: <br /> Relbyabbed 61' arr b nme ' <br /> a Mtle$atanee bY: aale: 'Tlae: <br /> r Ruelvl bT e:e: T{IDq wind by: <br /> o.mi nm <br /> 853CorC Orono 8 oratory Offloo 8 Labarabery Ornco 6 Laboratory O o S Lobo <br /> 853 Caparstlon StreM 2500 Slapwoach naaa 563 East LIn Av ,, 3x.42 Emp—orW9 Salta D �C°L Vb I'ry <br /> Boars.Paula,CA 93080 Stoo4on,CA 95218 Chfoa,CA 9SWS Sen alfa ObiBpo,CA 83101 9415 W_Ooonan Avenue <br /> TEL:(805)392.200o TEL:(2397 942-0182 TEL:(5907 3956010 TEL'Luis <br /> 783- V"10.CA 93291 <br /> FAX:(US)826-4172 FAX(209)9/2.0923 TEL:(5301343.3897 FAX:�BD67 783-2912 TEL'(559)734.9.473 <br /> FAX:(559)734$435 <br />