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rr 1;351 r r M r■r M M r = r r M r r <br /> A_p"l1ed P LChLaboratorvo Chain of CustAy <br /> 13760 Magnolia Ave. Chino CA 91710 <br /> A P C L Tel: (909) 590-1828 Fax: (909) 590-1498 Please Print in'pen Page r of <br /> Client: gE Z_} I �JG - Contact: N;4A0^ �. r]:� C 1 Tel #: 760 ZL1C. IFL//_I3Fax #: 2�19� /0�� <br /> Address: ED X 219 City: Wi~. i! I- i ,,,,vC,1 State: C A — - -- Zip code: CY Z .39 <br /> -,l V { <br /> bill to: � u N t , ` A'Js f, •a t ot, 3� E. �N,� f! . , fl �ovtox A C f) 9 �6r1 Analysis Items <br /> ProjetE Name/Code t n C Job # P.O. # t White -With report <br /> Project Address L1 Z S1 u{ Ar �;2 A 1~I APCL Quotation �# � „ Yellow - Lab copy <br /> Due Date: ❑regular ❑rush: _days _hours Sampled by: ; Pink - Originator <br /> Field Sample Sample Date Time Sample Preser- # of <br /> ID no. Description Collected Matrix vation Containers O? .?3 Remarks <br /> BUJ e X <br /> A <br /> PCi � X►Aw3 1 l� ;� . � ► � r x <br /> i a 1 2 �t it-41 V!c E X 1 <br /> �- L ; to K )', � Ie. iZ Ill 1 , : C t' <br /> 1N S til � � � g f;;l - � �CV x <br /> m W 6 1 L l A <br /> QC Requirement: Regular; ❑QA/QC Report; ❑WIP; ❑Raw Data; []Extended Raw Data ❑CLP; ❑ACE ❑AFCEE ❑NEESA_(E,C or D); ❑Other (Please specify) <br /> Sample Disposal: ❑Return NDisposal by APCL ❑Hold for days after receiving date. if not specified, samples will be discarded 45 days after samples are received. <br /> Sample Conditions: ❑Intact; []Broken. Cooler Seal: []Intact; []Broken; ❑ None . Tag ; Temperature: ❑ Room []Cold ( °C). <br /> Relinquished Date/Time /2//Jl7(5//0*C?5 Received by c Date/Time/Z/ke 'e//U" <br /> Relinquisbed by Date/Time / Received by Date/Time / <br /> APCL USE ONLY Service # Note: <br /> Clients understand that all terms described in the proposals, quotations for this project, and/or the general terms provided in the current APCL price schedules will be followed. APCL reserves the right <br /> to terminate its service or withhold delivery of any reports, if in APCL's sole discretion the terms of the project have been broken. <br /> APCL F— 4-101.w„" 4 0, Dec" ?0; 1994. Root-fita:[CUST.DATA.LA RICH A IN_RODT.TEx Pi],.JCUST.DATA LABICHAINa TEX <br />