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ENVIRONMENTAL CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT COPY 2 <br /> CLIENT 1REPORT11 INFORMATION <br /> Client: 0 14 Fs/, �Y ���Yf�L �j��� (s); � Rush Analysis(surcharge will apply): <br /> 7" Sampler ❑ S Day ❑ 4 Day Ll 3 Day . <br /> ❑New Custome�r't C s[omer Number: <br /> Address: �/ 7�1 ❑ 2 Day ❑ 24 hour <br /> [HCl <br /> '?��3 9 ! Comp Sampler Setup Date: Time: Rush pre-approval by lab: <br /> 11 initai <br /> Phone: Mileage: Electronic Data Transfer: yes no <br /> FAX: �G'U " , � If yes,To:State_ Client Other <br /> / <br /> Project name: / f A(2.Q..�A / Shipping Charge: Pickup Charge: Lab number <br /> Contact person o <br /> Billing Information(if different from above) � <br /> Name: Sit a g v <br /> o <br /> n Ci. <br /> Address: m z <br /> R o 3 3 O 3 Q p 0 !~ <br /> as z <br /> Phone: f7 > <br /> FAX: U c On o U N W <br /> Contact person: o 3 3J U N Z rrj '` <br /> a 4 E t] fl X41 V <br /> Purchase orderlcontract/FGLguote number. e <br /> o [7 v era x" F" p r <br /> Pre Log Required: yes Frequency: Other Month]y ❑ Weekly O Quarterly G ab y a O <br /> R o G z 3.3 C7 cn 1 x vj <br /> OSAMPLE INFORMATION SECTION IV Uq z ;. m y r� � ,'. v 1l <br /> 46 <br /> Sample Location/Description Date . Time °�' ° 3 `" v E N x <br /> Number Sampled Sampled P Z t= a N ci E <br /> SEPT lc "T-AAIK ~Fftar_1 J;r r fz3S 4 z 1 I N VJV _ X X <br /> C <br /> REMARKS CUSTODY <br /> E <br /> Rc N ' by and subj tams and conditions on the reverse of thyhiiisoc <br /> s dum nt: <br /> ,� Date S _27 me f <br /> f <br /> Rdinquishedby: Date Timc <br /> Received by: Date Received by: Date Time <br /> r <br /> Relinquished by: Date Time Relinquished by: Date lime <br /> Received by: Date Time Received by: Date Time <br /> CORPORATE OFFICE&LABORATORY OFFICE&LABORATORY FIELD OFFICE <br /> P.O.Boa 2771853 Coepomtion Strew 7500 sm eceach Road Visalia.California <br /> Santa Paula,CA 93061-0272 Stcehton,CA 95215 T"-'.tea.ee» <br />