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THE CHAIN OF CUSTODY/ANALYSIS REQUEST <br /> WINING2527 FRESNO STREET•FRESNO CA 93721•PHONE(559)268-7021•FAX:(559)268-0740 <br /> ORDE <br /> LABORATORIES , INC . <br /> ANALYTICAL CHEMISTRY - ENVIRONMENTAL SERVICES PAIGE <br /> GEOTECHNICAL ENGINEERING - SAMPLING SERVICES <br /> ' CONSTRUCTION INSPECTION & MATERIALS TESTING <br /> REPORT TO: ❑INVOICE TO: ❑REPORT COPY TO: REPORTING: <br /> ATTENTION: ATTENTION: ZL STANDARD PRINTED REPORT <br /> Qjn ❑ WRITE-ON (STATE FORM/EDD/EDT) <br /> NAME: NAME: (please include system ID#) <br /> ADDRESSS:: ADDRESS: <br /> � ElGEOTRACKER/COELT (LOFT) <br /> 1 <br /> �rQ-siro ��T-, ElCounty DHS: <br /> (,A a t ❑ Environmental Health Agency <br /> PHONEE:�G4 �7 PHONE: <br /> FAX: FAX: El OTHER: <br /> >'M aCoB 7(9Ce <br /> SAMPLE INFORMATION SAMPLE TYPES: PROJECT INFORMATION <br /> SAMPLED BY(PRINT): SOLID: CONTRACT/P.O.NO.: <br /> BS- BIOSOLID <br /> slot A CR• CERAMIC SITE; <br /> <Sp SOIL/SOLID -� <br /> LIQUID: PROJECT NUMBER: <br /> ❑ PUBLIC SYST E DW- DRINKING WATER L-( 2- <br /> ' ❑ PRIVATE WELL ❑ REPEAT GW-GROUND WATER PROJECT MANAGER: <br /> ❑ OTHER ❑ REPLACEMENT OL- OIL <br /> SF- SURFACE WATER ANALYSIS REQU TED <br /> TURN AROUND TIME: ❑ RUSH, DUE ON: ST-STORM WATER <br /> 1 STANDARD - WW-WASTE WATER <br /> NOTES ON RECEIVED CONDITION: y <br /> L ❑ CUSTODY SEAL(S) BROKEN ❑SAMPLE(S) DAMAGED �9 <br /> ' A <br /> B ❑ON ICE ❑AMBIEM TEMP. ❑INCORRECT PRESERVATION �( � '�• � /) v1 <br /> t <br /> U (Y { <br /> 1 Sada <br /> E <br /> CLIENT SAMPLE ID DATE TIME TYPE LAa usE <br /> a.., 1 PC <br /> �j— `J -7 /boo .5L- <br /> Will, <br /> DC <br /> (b- <br /> WN <br /> 'a Q " 3 Q' 31 I o3S ),C a <br /> Q' 1 I�Uf� pT DG (� 060 <br /> Li <br /> COMMENTS/ADDITIONAL INSTRUCTIONS: <br /> _REL QUI - ��/ _ _ COMPANY DATE TIME RECEIVED BY COMPANY <br />