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ENVIRONMENTAL CHAIN OF CUSTODY ORIGINAL. <br /> AND ANALYSIS REQUEST DOCUMENT <br /> _ ~ Ruch Analysrc 5 Days 2 D-kyc 24 hr. <br /> Client �n' , �1 �L �U• C Sampler{s) l( '� S� Subject it)surcharge <br /> Customer Number _5-2315 J QAlQC report required yes no <br /> Address �D X �0 e� Electronic Data Transfer yes no <br /> c G' / Comp Sampler Set up Date Time <br /> d L lb If yea,To State Client —Other <br /> Phone / f , ,Z <br /> Time ']Oy/_ Mileage Lab number `FAX O j - <br /> Lab Loc SP ❑ STK ❑ VI ❑ ❑ <br /> Project name <br /> Contact person cl or,-c I/ <br /> Bdhng Information(if different from ibove) 6 <br /> a V r <br /> Name <br /> Address ., r,� u Q <br /> i7 O 3 5 0 '� x t� <br /> e^ 3 0 u X <br /> PhoneC7 o m n y c i Q > <br /> o e C O :3 u N <br /> FAX w u bra rn cbCn z{ <br /> Contact person A A w + i j V a u <br /> v <br /> L) u <br /> Purchase order/ConlracVFGL quote number {j � 5 o ro E 0 a Q Cq �- <br /> Pre Log Required yes no z y in T z xtn <br /> d t ` l <br /> C6 3 <br /> 'o ea m er m Q <br /> 0 a rnCL u x'� �` a O <br /> Sample Location/Descnption Dale Time a <br /> Number Sampled Sampled h Z <br /> ?; D w m a r= U <br /> /2'l z -41 2 z <br /> SI:C'I ION VI <br /> Reltnqutshed by an cel to a lemv end condttront on the mvetse of thdocument <br /> L-_ Daley x / e �5� ROmquiskxd by Datc —�7�I "i ime <br /> r � Jf{_rrQ <br /> rtJ E`f v�{py Due / f rime f�1 I� Rc e,.cd by -f Date'JI 1 �j Time <br /> L x���. , _ 14 Li :I 9-2y-� <br /> R�gigt Date Tinu Relinquished ,�- Date�Time <br /> OUND <br /> Recesred 6y once Time Recewd by Dale Lnic <br /> r <br /> CORPORATE OFFICE&CAIKMATORY OFFICE&I ABORATORI FIELD OFFICE <br /> so <br /> O Bos 27L'A53 ration Street 2500 Stagecoach Ro+d Y9alm Cal rornn <br /> SuPaula CA 272 Stockton CA Tel Morn209)734 9471 <br /> 9i7372399 <br /> Tel (905)659 Tel{2091 96 OCT 2 2 1998 FAX(209)738 9435 <br /> FAX (W5)525 FAX (2091 <br />