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0 <br /> Dater , 9 4 THE TWINING LABORATORIES, INC, Pap-Df <br /> 2527 Fresno Street, Fresno, CA 93721 t ` <br /> . <br /> € M 268-7021 ` <br /> f <br /> Chain-of-Custody and Analysis Request Record <br /> s <br /> _ fYProject Nav r, Project N Project Manager- + L <br /> Sampler.--MC%- v►q Company_ l ub rti'^5L_r�loa ke% z csPhone- S 2 5 - C' 4 G Del <br /> SEND REPORT TO_ MPLING LOCATlO O - ILLIN Circle One). .�— '�EtrTb OUND: <br /> Company_ F.I t r.c x Cc ws f v"\% `_jck,' Cc. Companyr v �L�S*V 'o Flush <br /> Address: Z DO G V'+� Address: 1 �an e Ssc �1 Routine <br /> L <br /> (A- s f- 5A c iia V%'r-��� , C,�: �S f �; � _���-i- �ac.1�_��s�_,_C,dg7 sK�Z% (Specify Time. � <br /> Contact Name: 1My. 5 fiE' UC_ ¢a+ n. �_ Contact Name. '1 ��� sok fV% <br /> Phone: ! 3R i ?� S ohnr�e. ; f <br /> -COPIES To: ` <br /> Analysis Request <br /> a <br /> Lab' Client Sample Sample batelTime ber of <br /> ContWnem <br /> ID# ID# Description Sampled Ana.5•sis Requested Per Sample a <br /> r <br /> num <br /> VSA <br /> R <br /> ## L 1t 1)rc xi <br /> Vk <br /> CONDITION <br /> i <br /> 1111�we only. <br /> _ �y�,r�J�►•c _ ° 3. - • � <br /> elinqulshed By Aff"Ila[ioP [efTime rteceived y Affellation D:tellri jw <br /> ffA <br /> Received By Aff Ilahor Da'e!i riv Received in Lab By A'hhaton DataT„r,e <br /> a. <br /> . y <br />