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N V[RO N M EI`NTAL CHAIN OF CUSTODY <br /> ANDANALYSIS REQUESTDOCUMENT COPY 2 <br /> ^ SECTION ' r r , s ' , ' , <br /> Client: ��1.DU t"1 {•�S Sa C- . Sampler(s): -`I r--)4 j�l D E 2 Rush Analysis: 5 Days _ 2 Days_ 2q hrs._ <br /> ' I Customer Number: Subject to surcharge <br /> Address: QA/QC report required: yes no <br /> ST�eIGTJr-J eA 45a o� p P P 2'ZI'9 1/%00 Electronic Data Transfer: yes no__ <br /> Com Sam ler Setu Date: 7 Time: <br /> If yes,To:State_ Client _ Other <br /> Phone: 4�y I -9 15 Z <br /> Time: Mileage: Lab number: <br /> FAX: <br /> Project name: _'J &s2,--r 'N G /� !�� Lab Loc: SP ❑ STK ❑ VI ❑ ❑ <br /> Contact person: Ct��� N �U✓X ZA IBX I<I Ue r- 8, <br /> F <br /> Billing Information(if different from above) _ u <br /> u <br /> Name: u c fi y <br /> Address: 3 C <br /> o <br /> Phone: C7 o Fo e u y z n p <br /> v <br /> FAX: o f t= c` <br /> Contact person: �, m ;,.^ ,� U �_ 'ao N Z C L. x <br /> c o <br /> Purchase order/contract/FGL quote number: c u, I ' `• '" m y �• 1.. Z <br /> U `v O o <br /> Pre Log Required: yes _ no Z b 2 2 z ° d <br /> e Cy n <br /> ti <br /> SAMPLE INFORMATION y U C C v <br /> c $�y <br /> Sample Location/Description Date Time aa. E t 6' 3 3 3 y fg F u y C% a g <br /> Number Sampled Sampled FT z a 3 w W m <br /> MrliO Z92- S, CAt JNJE iZV Z-zl 10 0e '�:l 3 IVIP ow X <br /> r y <br /> Custo <br /> 1 <br /> -CTION VI <br /> F77 <br /> y—_ Dalen/ I Tme Reliipuishd by: Da¢ Tme <br /> Received by: - t7ete`-�{� Timel I - Raeivedby: Dule T, <br /> Reliipuisbetl Dve Tru: ReliNuiMdby: Dare Tme a <br /> N <br /> Received by: Date Tme RereivW by. Dare <br /> Tm <br /> CORPORATE OFFICE a srr• 'ATORY OFFICE R L h Rona ORV FIELD O CE <br /> P.O.boa2]21858C 1.0rlt Soca 2500l.,CAcb Road Vissfi/.Colifonna <br /> aaala Paule.CA WDfiIATR Rel:(20% Of I5 Tel:(209)]3{.9073 <br /> Tel::0105)(805)59-0910 Tet(209)902-0rs1 <br /> FAX:fsoA 52501]2 FAX:(209)982-00D Mobile:QW I]8]-3399 <br /> FAX(I(19)7348035 <br />