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��76rnCHAIN OF CUSTODY 1 LABORA Y ANALYSIS REQU F & <br /> 00 Purchase Order # Page 1 of 1 <br /> 1433 North Market Boulevard,Sacramento,CA 95834 Service Reglest No <br /> I_ab <br /> sEm_c_on_(916)928-3300 FAX (916)928-3341 _ <br /> Probed Name. j)CV, ?- �a <br /> Anal sis Re nested <br /> Project Number Zbl yl00 Q 7�3 <br /> Projcct Manager Claudio Avila <br /> FVU-2 ENICON <br /> Address 1433 North Market Boulevard a N <br /> Satraniento,CA 95834 U <00 <br /> DQo � <br /> Phone (916)928-3300 o v u <br /> FAX (916) 928-3341 <br /> Sampler's Signature REMARKS <br /> I Z <br /> Sample LAB Sample <br /> ID Date Time ID Matrix <br /> r -- Z r 5-BSIZ <br /> ZG <br /> 4'�7lolrrG t' ~- Cam )e � <br /> RFI {N(�UISt1EU BY <br /> RECEIVED BY TURNAROUND REP[)RT RE(1UIRk Nil N r <br /> RLi 1 QUISH> U 4 REi N 1V BY RH QUIRFNII NTS I Routine Report <br /> l t <br /> Signature 24 Iv 48 hr X 5 day Il Report(indudt.s DUP MS <br /> SIuU 1 t� S[gpalure D Signature S -r""� <br /> Standard 1-to-15 working days) <br /> MSD asrequired maybe <br /> \ Printed Name Provide vcr6zl Palrrruna y Results Lllargcd aS SJ]11pICt) <br /> Pnu1Ld Name 1 � Pnn(e�!ja{r]�n„ Printed Name <br /> Prande l AX Prehrtvnary Resuhs ItI Data VatI(1J110n Ret7Ur1 <br /> fir[n Finn Rrqueaed Rcr rt{lade (ul�ludt+All Raw Dila) <br /> RWQCB <br /> (MDI slPUL+IIRACEJJ) <br /> Datclrunc. <br /> Date/rrme Dale(rimc Ualclrinie Con(nnt.rType%KLy <br /> nsi ruetionsiComments <br /> Kl 1 [N(?1JI5111 U 11Y R>'[,>rIVF U uY special t 40,,,I VOA I <br /> 125(til LYE 2 <br /> Slgnamre Signame SW 1W LPE I <br /> I leer I IDPE 4 <br /> Printed Name Printed Name 5W ml glass 5 <br /> 1 Iller glass 6 <br /> Firm Firm 2x6 s!s ring 7 <br /> lass jar 8 <br /> Mir/Time - _ _ <br />