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/,7� .�q/, CHAIN-OF-CUSTODY/Analytical Request Document <br /> ;a eAnary,5a The Chain-of-Custody is a LEGAL DOCUMENT.All ielevam fields must be completed accurately. It Vl <br /> 'aara'�pxebls.aam <br /> Page: � pf � <br /> Section A Section B Section C <br /> Required Client Infonoabon: Required Project Information: Invoice Infometlon: `� 7 JI n 1 C C <br /> Company: Report To: Atlandpn. 1 [.�. (L �J J <br /> T2c �I>aler�e..�.c.n�sut lckrti 4. SLhNi� fb51�a�V <br /> Address; I' ( � ropy"': <br /> Company Name: Ie REGULATORY AGENCY <br /> d12 I.LI.(,2 1 <br /> Address: 6OJ'L l.wu-LAJ( Cyt l03 F NPDES r GROUND WATER r DRINKING WATER <br /> C iPaw Quota UST j— RCRA r OTHER <br /> ErnNil T : Purchase Order No.: Pa.0 ce: <br /> C' <br /> Ph ne: Fax: Roles Name:{ �/� Paw Pi°lem - \ O Site Location <br /> .[13 4P{t. F �Dl ttlz< 1e 10.M11$�tL.� t� �T Mana9en .� /A <br /> RAT: Projen Number: Paw Praia k. STATE: <br /> Requested Due Date <br /> torr M GP-T2,)°I Z5, o�L <br /> `Requested Analysis Filtered.(Y/N) <br /> y <br /> Z: <br /> Section Matrix Codes a COLLECTED Preservatives 5: <br /> RegalredClient lnfmmasan MATplx ICOOE — o <br /> Drinking Water DWWater WT $^ p <br /> S D COMPOBIiE CCMPQSI <br /> Waste Water WW up Q z <br /> m m STPAT ENOMAAB y m <br /> Product P y <br /> SoiV0 Solitl SL g 0 <br /> SAMPLE ID We. WP – z <br /> (A-Z,0.9 f;) Air AR p a <br /> Sample IDs MUST BE UNIQUE Tssus TS O <br /> Mer OT O JO m O c ?` <br /> E' 0 0 = N t m C N <br /> O <br /> o <br /> W N DATE TIME T.� TIIE y _ _ Z Z O y Pace Project NOl Lab I.D. <br /> ` D2 WT 5/tl1A 440 2 <br /> t lttbrb' o 2 �.. <br /> s _FNA T[3 d j 1 4oeKv Z <br /> a i rpt -Gu?-7 I Z wt G /Illi+ 501'70 �t 3 Lv <br /> s T \ hw--2-2 1 I`P UD0 to <br /> s — .yd 5 l IAic <br /> T Ik i5 D <br /> T-4-2.0 QCs m5o °1 G <br /> fo w -TS- zv <br /> it <br /> '1Y ` SAMPLE CONDITIONS <br /> ADDITIONAL COMMENTS RE NOUISHED BY I AFFILIATION DATE TIME <br /> ACOEPTED BY/AFFILIATION DATE :TIME <br /> Gae ltT f a? IW IIIS 214 �) IS <br /> jAA-T -62 GtDOler Y <br /> rPA--B 'OS (ooict­ 2. <br /> iM T13 D LA cuvlrV­ <br /> N SAMPLER NAME AND SIGNATURE 'a <br /> om <br /> 0 ORIGINAL PRINT Name of SAMPLER: /4 u-ITl <br /> DATE Sigrietl 2 r C rn <br /> SIGNATURE of SAMPLER: (MMIDD/YYJ: a/ 1 <br /> ' F-ALL-Q-020rev.01,15-May-2001 <br /> -InPitard Nde:By apning In,bur,Yau are a aeptag Paces NET 30 day payment hams and a,m,,totale clMryes&1.5%per monm for any inwiwslwt paid whin e. <br />