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CLS - L( )S CHAIN OF CUSTODY f CLS ID No 9���l LOG N0. 1C 197 <br /> REPORT TO: CLIENT JOB NUMBER ANALYSIS REQUESTED FIELD CONDITIONS: ! <br /> NAME AND ADDRE <br /> EjeWz DD <br /> 41 <br /> DESTINATION LABORATORY <br /> Q / � <br /> FED CLS (916) 638-7301 <br /> 3249 FITZGERALD RD. <br /> PROJECT MANAGE ONE# m COMPOSITE: <br /> RANCHO CORDOVA,CA. U) <br /> PROJECT NAME 95742 m <br /> m <br /> SAMPLED BY IC D �I ❑ OTHER <br /> JOB DESCRIPTION m rn <br /> N TURN AROUND TIME SPECIAL INSTRUCTIONS <br /> SITE LOCATION 0-1Q <br /> SAMPLE CONTAINER \ o o o ovyu <br /> DA7E TIME IDENTIFICATION MATRIX NO. TYPE <br /> knI 6 <br /> m <br /> INVOICE TO: <br /> P.O.# <br /> QUOTE# <br /> SUSPECTED CONSTITUENTS SAMPLE RETENTION TIME PRESERVATIVES: (1)HCL (3)= 0 <br /> (2)HNO 9 <br /> LINQUISHED BY(SIGN) PRINT NAME/COMP Y DATE/TIME RECEIVED BY(SIGN) PRINT NAME/COMPANY <br /> It <br /> A) e % J_ <br /> RECD AT LAB BY: DATE/TIME: CONDITIONS/COMMENTS: <br /> SHIPPED BY., ❑ FED X ❑ UPS OTHER C-L C « - AIR BILL# <br />