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CAST* ANALYTICAL LABORATORY CHAIN OF CUSTOO <br /> Location: 2333 Shuttle Drive, Bldg 908/909, Atwater, CA 95301 Certificate No. 2079 <br /> Mailing Address: 2333 Shuttle Drive, Atwater, CA 95301 PAGE—A-01' <br /> Phone: (209) 384-2930 - Fax: (209) 384-1507 <br /> REQUES ANALYSES Method of Shipment• <br /> Customer: l etice `' ? `t `G: i tt k t 3 i '—''4 <br /> Address: a ,; ►' �, ! m r �� : <br /> City/State/ZIP: ��u (_', " Z N, !�4 " <br /> v <br /> Phone 1 FAX: 7. —t s 4 N m t::' pp p 0p, <br /> Pro I P.O. 11: a. <br /> a ` u+ za m w rQj , 'Ir �J 1 4 <br /> t P 5 C � a o x LL , err <br /> 0. <br /> Report Attention: a E w <br /> Sampler Signature: 8 <br /> ";' <br /> Printed: u <br /> z <br /> Lab IN SAMPLE ID DATE TIME DESCRIPTIONILOCATION ''�•+. s`i % "t� '�K, <br /> 2-0 <br /> o <br /> ' '' .Y.. . <br /> L <br /> 9 C � <br /> MW-4 <br /> W• <br /> Total number of containers submitted to <br /> Signature Printed NaTt Date Time Company Name the laboratory <br /> Relinquished by: ' ' l f" '(J r? Note:All special requests(e.g.quick <br /> turn limes}must be cleared through <br /> Received by: H 1 lir/q J S '15-- CV30 Z& /,/ authorized laboratory personnel. <br /> Relinquished by: <br /> Received by: <br /> " RESULTS DUE <br /> Relinquished by: VERBAL wRtT7Ek <br /> Received by: �•�v <br /> a.=mHEAD SPACE ASSENT__Ae CONTAINERS.__,,, <br />