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ENVIRONMENTAL Weekly CHAIN OF CUSTODY <br /> a <br /> Y <br /> Laboratory Copy (1 of 3) <br /> ill-0111 Fill M11111 30007:04/05/2004 TEST DESCRIPTION - See Reverse side for Container,Preservative and Sampling information <br /> Client: Clark Well Inc. - <br /> Address: 2024 E.Charter Way O <br /> Stockton,CA 95205 <br /> O <br /> Phone: (20962-7676 Pax: (209)462 5597 2 <br /> Contact Person: Mike Clark " <br /> U W u <br /> q u <br /> Project Name: <br /> C7 a wuty <br /> Purchase Order Number. <br /> :r(s) o <br /> C W a v 7 <br /> h z v F <br /> m o O O <br /> C <br /> Or O <br /> Compositor Setup Dale:_/_/_ Time: te_/_ .Q o ' <br /> a z z r <br /> Lab Number: STK 3-2347 o a <br /> o <br /> amp Uate Time $ n 5u o <br /> Num Location Description Sampled Sampled F E✓ 0 M ti <br /> I S fno 9 Iz <br /> 123 G Src 1 , <br /> Remarks: Relinquished Date: Time: Relinquished Date: Time: Relijtiuised Date Time: <br /> keceived By: _ Date: Time: ReceivBy: - ate: Time: i By: Date I Time: <br /> ed <br /> Corporate Offices&Laboratory Office&Laboratory Field Office <br /> P.O.Be.272/853 Corporation Street 2500 Stagecoach rroap Visalia,Calliornia <br /> Sanla Pqula,CA 93061 0272 Stockton,CA 95215 TEL:(559)734-9473 <br /> TEL (805)392-2000 TEL: (209)942-0181 Mobile:(559)737-2399 <br /> IFAX: (805)•5254172. FAX: (209)942-0423 FAX:(559)734-8435 <br />