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MOCT-EDORB 'FRATOMIS 2Z <br /> A F <br /> 806 N Batavia 0 Orange GA 92868 � CH CUSTOD ECORD <br /> (714) 771-6900 0 FAX (714) 538-1209 <br /> Date � Page 'Pof� <br /> CLIENT /�` / U 00 <br /> ADDRESS I S/ Lam,L' i PR YO� GE�-(�' ` <br /> lX7v N� Samples Intact Yes No <br /> County Seals Intact Yes No <br /> P NE NUMBEf c—>t�j Sample Ambient_ Cooled_ Frozen_ <br /> PROJECT NAME SAMPLERS ( nature) `U �/ Same Day 24 Hr <br /> Regular 46 Hr <br /> SAMPLE TYPE OF SU SP <br /> NO <br /> SAMPLE LOCATION DATE TIME NO O i CSU TESTS <br /> NUMBER DESCRIPTION WATER AIR SOLID CNTREQUIRED <br /> S t u _ ✓ SIC �'�L /'" �(' 51, �A��'i 7? <br /> Iwo <br /> I <br /> Relin u h d by ( ature) Received by (Slgrfature) Dat /Time it hereby authorize the performance of the above <br /> indicated work <br /> Reiff quashed by (Signature) Receivedby L Zlo� for analy is rQ�pjJ ate/Timi /3 <br /> {Signature <br /> 4F <br /> Special Instructions �1/ <br /> DISTRIBUTION White with report Yellow to AL <br /> Pink to Courier <br />