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ENVIRONMENTAL CHAIN OF CUSTODY ORIGINAL <br /> 4 AND ANALYSIS REQUEST DOCUMENT <br /> C./—,4 �' , Rush Analysis 5 Days 2 Days 2S his <br /> Client ��� Ll !�. �U. Sampler(s) �t Subject to surcharge <br /> Customer Number 3T Z� �� QA/QC report required yes no <br /> - <br /> Ru <br /> t� -D u �0 Electronic Data Transfer yes no <br /> Comp Sampler Setup Date Time <br /> a �� �l b !C yes,To State Chem Other <br /> Phone ?�) <br /> FAX _ is c7� ti J �to Time ��O�f Mileage Lab number f L <br /> Lab Loc SP ❑ STK ❑ VI ❑ ❑ <br /> Project name /J <br /> Contact person r/ <br /> Billing[nformanon(If different from above) a u <br /> Name ru x 4 <br /> 77 <br /> Address 3 x C: x e" <br /> O 3 O_ .. ov Q O_ x <br /> Phone C7 o iA c o a) N v M tr y <br /> FAX r tr i a 0 "' o <br /> Contact person $ n �, H I n + i ! u Y U <br /> Purchase order/contract/FGL quote number to a o v E zj 0 o Q Z <br /> Pre Log Regwred yes no to � `� z y � H � � z z � <br /> _ , <br /> a. a �, 33 5 to N :, <br /> N F <br /> U v uv 3 .] in u a) " O t, <br /> u <br /> e ,Yll <br /> Sample Location[Descnpiton Date Tiime <br /> Number Sampled Sampled <br /> I <br /> I <br /> FR� <br /> ed by an cct to c terms and condition on the reverse ort moment <br /> 7 <br /> w '(f ('� �� Date Time Re]ingw9xd4by ; Daeert" G J f ,'� lvYDade / Time 1 J r 1J Received 6yDate'�I _ Time <br /> gu iDate��l- I Trme RehrgtnslxDate Time <br /> , REYHOUNUy r Date Time Received by Date Imx <br /> FIELD OFFICE <br /> COR OFFICE&L TORY OF0[Ft[CE k t Ap Road TORS Yisa[rk Cabromi�~ <br /> PO Boa Corporation Street Slac 95215 Tel 1209)734 9� <br /> 7<<�5, ;a I-0272 Tcl FAX <br /> O04 OCT 2 2 1998 a't'0. ell, <br /> FAX (8051525-4172 FAX 12 9420423 <br />