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Chain of Custoc <br /> P L13160 Magnolia Ave. Chino CA 91714D <br /> 1 Td (904)541}1828 Fax: (909) 5901498 Please Print in pen Page of <br /> Chant_ 3G S l t�1G Coatart: it Glk >r t.1�2�{G Tei #:T�p • Ft�t #: <br /> 2 <br /> Address: � �'� �•• -'+ <br /> '�3 <br /> City: �)�1iF�►t# t <br /> $i11 to. ��?�T7��-•(`LYaI `�� State:C,d Zi code: <br /> �WT�%�? t- �. Nt�{{CvC -( .w t`tV Y1� 9170 Analysis Items { <br /> project 'Vame/Code�KF;-y lab # P.Q # �! White-Wish rwo <br /> Project Address 42-92l (Z �� �. '� APC1.Quutalion # t/l Yeitow -Lab o0 <br /> D F. <br /> DDC date: ❑regular ❑rush: _days`]tours Sampled by: ♦ F' (0 pi,� -ori <br /> DCNI i y°'t°r <br /> : fl I <br /> Kidd Sample Sample Date Time Sample Preset- # of +`i Lo_ _N <br /> n ,1D Na. Description Collected !Matrix ration C*nteiao-s Remula <br /> t <br /> n N Et S ( 1 i tcL :X•St's L j cf- <br /> F J <br /> �=tJ H1 \I t iii i-►GS 1 <br /> !�t[) i <br /> „t'i <br /> ;.;Z` _tii-f jam- � tib• <br /> z , <br /> Y1� 1 tri.'_ acr:Tt{ <br /> QC Regabremenc: Regular: ❑QA/QC Repel; ❑WIP; Olt..Data; ❑Extended Raw Data ❑CLP, -IAC ❑AFCEE ❑NEESA—(E,C or Dl: ❑Otte (p, aa�*fyE <br /> V Sample Disposal ❑R.(. • i)-potal by APCL OHId tot day.arty reoei.iog date. <br /> If ant speciRed,sumpiAa will be discarded SS aA <br /> dqa err awinpilea era reeli+rd. <br /> ~ Sample Cond>�� jnlact, nBroken. Cooler Seal: ❑]matt; ❑Brc&eu: ❑ None. Ted Temperaliue: ❑Rooar ❑Cold L�"C). <br /> Relinquish b _/� <br /> 4 Date/Tune Cr / d Rcttived by ✓' �i' y��� Date/Time �� <br /> Relinquished by Datr/Time / Received b G• / �If ` <br /> + Y Date/Time / <br /> Lf A PCL 65E ONLY Service # <br /> n Note:: <br /> Client.ondesatand that all terms dumbed is tbt propombs.q6Kota6ave for thr project, aedlm the aenerai terms prvrided in the current APCL price"ad.l.s+rill to followed APCL rearrxy the--9Mto ter.ainste its a+ry ar„ltblwid de4t e" of any reports, if in APCL',sole di.ctctinn the ttreut d the jvct havr been broken. <br /> caret�..� .... ....a.. aq .a.._ Rg4l4Ie-1sT.O�Tw�.A 11�CMwIM_a007.76i ►e.,IrvaT •V• ■ ' <br />