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1 1HL CHAIN OF CUSTODY/ANALYSIS REQUEST <br /> TWINING 2527 FRESNO STREET•FRESNO,CA 93721•PRONE(559)268-7021•FAX:(559)268-0740 <br /> 'IJ ,WORK ORDER #; �� <br /> L A B O R A T O R I E S , INC . s y x x <br /> ANALYTICAL CHEMISTRY - ENVIRONMENTAL SERVICES <br /> GEOTECHNICAL ENGINEERING - SAMPLING SERVICES <br /> CONSTRUCTION INSPECTION & MATERIALS TESTING <br /> REPORT TO: ❑INVOICE TO: ❑REPORT COPY TO: REPORTING: <br /> ATTENTI,gqppN: ATTENTION: STANDARD PRINTED REPORT <br /> V�h ❑ WRITE-ON (STATE FORM/EDD/EDT) <br /> NAME: NAME: (please include system ID#) <br /> �w,ti l c wT eS <br /> ADDRESS: ADDRESS: ❑ GEOTRACKER/COELT(LOFT) <br /> ❑ County DHS: <br /> ' El Health Agency <br /> PHONE: PHONE: <br /> ate$-?aa( I <br /> FAX: FAX: 11 OTHER: <br /> �s5 - <br /> SAMPLE INFORMATION SAMPLE TYPES: PROJECT INFORMATION <br /> SAMPLED BY(PRINT): SOLID: CONTRACT/P.O.NO.: <br /> BS: BIOSOLID <br /> SIGN E: CR- CERAMIC SITE: <br /> IL/SOLID MSE <br /> ❑ PUBLIC SY UTINE LIQUID: PRIOR'TNUMBER: <br /> DW- DRINKING WATER p L'l.'-la1 X02 <br /> ' ❑ PRIVATE WELL ❑ REPEAT GW- GROUND WATER PROJECT MANAGER: v v <br /> ❑ OTHER El REPLACEMENT OL-OIL .v�� <br /> SF -SURFACE WATER ANALYSIS REQUPTED <br /> TURN AROUND TIME: ❑ RUSH,DUE ON: ST- STORM WATER N <br /> STANDARD - WW-WASTE WATER <br /> NOTES ON RECEIVED CONDITION: <br /> L ❑ CUSTODY SEAL(S)BROKEN ❑SAMPLE(S) DAMAGED _IA <br /> B ❑ON ICE ❑AMBIENT TEMP. ❑INCORRECT PRESERVATION � 41 —� <br /> V <br /> E © <br /> CLIENT SAMPLE ID DATE TIME TYPE vj LAB USE <br /> kx <br /> 13-41Q ( 7-� /r3 �L <br /> t <br /> t �1� (3-`( <br /> r <br /> �f-a* <br /> r <br /> L�4. <br /> COMMENTS/ADDITIONAL INSTRUCTIONS: <br /> r <br /> RELINQUIS BY COMPANY DATE TIME RECEIVED BY COMPANY <br /> 7-27-C6 /3.3CC <br /> a <br /> 1330 <br />