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r ►§0c1ffEr'RB00fflVS 'r rr rr r r� = r M r M M <br /> 806 N Batavia • Orange, CA 92868 2 <br /> CHA OF CUSTODOECORD <br /> (714) 771-6900 m FAX (714) 538-1209 Date 7, Page o <br /> 3 f a- <br /> CLIENT lA� Yo /`` 67')lg�Zjl <br /> L�L7�i �✓� 6 ROJECT MANAGER <br /> n,// ���� Samples Intact Yes No- <br /> - <br /> o <br /> ADDRESS <br /> Izw County Seats intact Yes No <br /> PHON NUMBER /'33_ �-6l� Sample Ambient— Cooled_ Frozen_ <br /> PROJECT NAME SAMPLER Signal C� Same Day 24 Hr <br /> O 7Sr� � Regular 48 Hr <br /> -27 f''�- <br /> SAMPLE TYPE NO OF SUSP <br /> SAMPLE LOCATION TE TIME CNTNRS CONTAM TESTS <br /> NUMBER DESCRIPTION WATER ASR SOLIDREQUfRED <br /> 6/0 sir �w /} <br /> 5,1-v C ofw <br /> Ir <br /> GCP ,� !, G' 41L <br /> Vo,7,72 <br /> �G lam- <br /> Relinqu ed by (Sia re) Received by (Si ature) Dat Tim;/7�lndicated <br /> I hereby authorize the performance of the above <br /> y� Z3 work <br /> l� k <br /> ReceivedALaboro ` sis Date/T+mRe quashed by {Signature} y '/�(Signatur �z Special Instructions DISTRIBUTION White with report Yellow to AL, <br /> Pink to Courier <br />