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VZRONMENTAL CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT ,PY 2 <br /> I <br /> Client '-�G E L 314 / Sampler <br /> am ler s W t"�C{ [1 Y Rush Analysis. 5 Days 2 Days 24 hrs. <br /> p �)' Subject to surcharge <br /> Customer Number: _ <br /> O' a CI ��/ ti,/��F L�iC�/IJ or•- Z QAJQC report required: yes no <br /> Address: �J (U. Yr�.+�.� x �+r Electronic Data Transfer. yes noy <br /> O tm C 9520 Comp Sampler Setup Date: Time: <br /> v Phone: 9-6.6 - 5-7 -71 If yes,To:State_ Client _ Other <br /> P7M. '5172c- 9,71 a,, Fir w f- Time: Mileage: Lab number: <br /> r: Project name: 11610,-4+, s- o w eas e. Lab Loc: Sp ❑ STK ❑ VI ❑ ❑ <br /> t% <br /> Contact person: eo't * PC�"ti <br /> • A I <br /> a <br /> Billing Information(if different from above) <br /> Name- o U <br /> u o Rr <br /> Address: <br /> u 4 <br /> 03 y o 3 y oro a <br /> _ CJ <br /> Phone: C� O m iZ <br /> FAX. <br /> Contact person: o a: W 3. A U a N Z q V <br /> Purchase ordedcontract/FGL quote number: o 6 a F a F x <br /> Pre Log Required: yes no U 00 = �? Z � u � a Z O CO � Co z <br /> ,o, ,`aa, �• �j o <br /> SIM <br /> E V <br /> nowt tw .13 <br /> ula <br /> 1 q osz s w. w <br /> rn OMtg <br /> u E, E3`m <br /> 2 7 3 <br /> o wy ia O <br /> o o o <br /> pleLocationlDescription ° � <br /> Date i <br /> ber Sampled Sampled unx7z <br /> 4 <br /> �3 1 6 11 <br /> 0-1 W AT r-IS 1 -71 014 G-uNu-Z So- t / I0-3 T Xm-z7?--,Z <br /> CU, <br /> -m1C <br /> UbO?+ <br /> (614�2 -~ r. ' H 104 G 3 bw <br /> - S11zs - S <br /> D-3 WTi2 4` 1310 3 Lb �uw <br /> REMARKS SECTIONtl <br /> G Q (FSu 1 U Rd lnRai b ad the a�di,iona on the re use Of this I ` SECTION <br /> HI U 1'1 ► f ��SQC Date ��Time `O Relinquishes br Date l me <br /> Z�Zv GorYIG �Sla D✓ <br /> Regi by: Date l Y✓Tttne • Received by: ihte Time <br /> Rdi by: Date Time Relinquistied by: Date Ttme <br /> Rt"ed by, <br /> Date Time Reecived by: • Date Time <br /> CORPORATE OFFICE&LABORATORY OFFICE&L.ABORATORY FIELD OFFICE <br /> P.O.Box 2771853 Catpaatioo Sheet 2500 S h Road Visalia.California <br /> Santa Paula,CA 93061-0272 Stockton,`,CCA 9952t5 Tcl:{209)734.9173 <br /> TO!(805)659-0910 Tel:(209)942-0181 Mobile:)73 9473 99 <br /> FAX:(805)525-4172 FAX:(2091942-0423 FAX(209)7348435 <br />