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CHAIN OF CUSTODY <br /> ENVIRONMENTAL AND ANALYSIS REQUEST DOCUMENT ORIGINAL <br /> s Rush Analysts 5 Days 2 Days 24 het <br /> Client �- S �l co' Slmplcr(s) <br /> !l •7 Subject to surcharge <br /> ^ Customer Number 3- �� - QA/QC report required yes no <br /> Address Electronic Data Transfer yes no <br /> Camp Sampler Set up Date T1fT1C if yea,To State Client Other <br /> Phone d +� <br /> � � ` Time 7dyf._Mdeage Lab:umber <br /> FAX _ Lab SP ❑ STK ❑ V1 0 ❑ <br /> Project name <br /> Contact person / (.-53 t <br />� F a <br /> Billing Information(if dtiferent from ibove) x j <br /> Name ": x a a <br /> a � � <br /> Address [7 0 3 y p a <br /> O <br /> z <br /> N v <br /> C7 E in e v u v l h , <br /> Phone y e o <br /> Nty <br /> Z i; u <br /> FAX �- <br /> �j U <br /> Contact person o N at u <br /> Purchase ordcrlconuacUTGL quote number So c a y�j O 13Z <br /> Pre Log Required yes no c Z ti rn 0 a s o <br /> o 33 y y v u <br /> U y 0ew-0 4J <br /> l+ <br /> N > <br /> SECTION IVSAMPLETWORMATION c% o 0 3 k 4 Q ba <br /> 3 x q O <br /> oh V) <br /> Date ime W ~Sample Locallon/Descnpiton U a E <br /> U <br /> NumberSampled Sampled E�- z <br /> ZyCUSTODY <br /> `� Z <br /> SLCTION V1 <br /> Relinquished by a cit to a mems and conditions on the reverse of[his document `I-2 q fl <br /> n > <br /> Date/7 / c / Rchnquished by -Date me <br /> V w' '` j y <br /> t �j -/�r �� (..J �� Dale'-I �i f Time <br /> Dale / � ! Timc�J��-J Received 6y - <br /> .,r U i J I L� Lf f� Date Tient <br /> d i OUN�Date r��i_ f Time Relinquished ,r <br /> Received by Dine Time Received by Dem Ilnte <br /> i HELD OFFICE <br /> COR FOR FFlCE do L TORY OFFICE R LABORATORY Puha,Cahfornis <br /> PO Boa pipnratron Succi 2301 q I'll, <br /> Rind Tel 11 114 94 <br /> Santa Paul 1-0272 Smelt 215 hide 9)71 7) <br /> Tel(805)6 0 Tel {2 tat OCT 2 2 1998FAX(2c191714 9 <br /> FAX (805)525-4172 FAX I2 42 IW2} <br />