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1 <br /> DARPETRO , INC <br /> 3450 EL CAMINQ AVE • CEFiSS, CA 95307 <br /> FAX(209) 537-9039 - (209) 537-0771 <br /> ` CHAIN OF CUSTODY ANDANALYSIS REQUEST RECORD <br /> DATE:_ -7-ao �I 7 TURNAROUND; LAB DATE: <br /> STATION # SEND RESULTS TO: ROGER LISTON PRESERVATION HANDLING: <br /> NAME: 4 T L"i i �'� 3450 ELCAMIND <br /> ADDRESS: �� ��� >� t CERES, CA. 95307 STORED ON ICE UNDER 40 F. + <br /> PHONE: 309-537-0771 <br /> FORM 66 <br />' SAMPLER NAME; P.D. # U <br />' SAMPLE ID. SAMPLE DATE: TIME: SAMPLE TYPE SIZE TEST FOR BTX & E TPii-6 <br /> LJ <br /> 1 <br /> 1 <br /> RELINQUISHED Op RECEIVED Bl�, <br /> SIGNATURE: <br /> -1' SIGNATURE; <br /> TED: Ytj PRINTED: U j oi z z <br />?C0MFANY:3�, <br /> ti/' -. 7�' COMPANY: .?ff�,E_;,:1�n,r► LAOS- <br /> DATE TIME: DATE TIME: f/oo AM. <br />