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CHAIN OF COST � <br /> 5erv;ceg�� CUSTODY N° 99096' 9 <br /> Project 5090 Caterpillar Road•Redding,CA 96003•Phone:(530)244-5227•FAX:(530)244-4109 CSC# <br /> Purchase Order# <br /> # <br /> s r t ��.1 i�' Requested Analytical Method# THIS AREA FOR LAB USE ONLY <br /> Project Name Lab g <br /> ` ( Page of <br /> T <br /> Company Name T a <br /> L �p Lab PM Custody Review <br /> t �l <br /> Prlp)ect Mans er or Contact&Phone Report Copy to. Lo In <br /> (�`C l�rl -��7 �c 17 O ` * 9 LIMS Veriticatien <br /> Requested Completion Date: Site ID le Disposal: C JO <br /> X71 J'Pf .r -_r <br /> r N 'J P\ PH <br /> Custody Seals Y N <br /> T N' \� v} Ice Y N <br /> :D:. e Return q❑ 1 <br /> N Preservative(to be filled out by Customer) OC Level 1 2 3 Other <br /> Sampling Type Matrix ER <br /> C G 1N S A S Cooler Temperature <br /> O R A O I CLIENT SAMPLE 1D LAB <br /> Date Time P B E R (9 CHARACTERS) QC <br /> R <br /> /\ .0 - z Alternate Description Lab ID <br /> 1 c>ac� <br /> 1r35 X C P r <br /> 12-1 T <br /> Sa eddy nd Till ejyu (Please sign and print nam J <br /> � D��e Rel ishe / (Please signand print <br /> Dat i e R print name) �a/�im��� <br /> R Wed Bc- <br /> y i (Please sign an print name) 'nquished By (Please sign rint ame <br /> D, lA)� l� DE ��S nand <br /> 9 P ) Dateffime <br /> Received By (Please sign and print name) Datefrime Shi <br /> Aped Via Shipping# <br /> Special Instructions: UPS <br /> 1 "1 L j Tr3r1z f (�t< r T\sA , OpC/ P.O.# INVOICE INFORMATION <br /> Bill To <br /> me - isions <br /> 'erse <br /> Disf�uiions-Gr-@nal-Lab,Yellow-Lab,Pink-Client <br />