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A lied P & ChLaboratory- in of Custody <br /> �� � _ � Cha y <br /> 13760 Magnolia Ave. Chino CA 91710 <br /> . . . =� , <br /> A P C L Tel: {909) 590-1828 Fax (909) 590-1498 PIease Print in pen Page —L- of —_ <br /> C:licra: G. Contact: Tel #: Z� — yV Fax *:1760J ZW !914 <br /> Address: t Q Q City: T Dp State: -ACA— Zip code: f40 7 <br /> Bill to: T Q lJ ! PO q111al 001. ajlgr \ ': Analysis Items <br /> Project \arne/Code .lob # P.O. White - wuh report <br /> Project Address APCL Quotation Yellow - Lam copy <br /> Due Date: �tegular ❑rush: _days __ hours Sampled by: �r7eZ11�( f !tj \ pink - Orig:�acor <br /> tls i <br /> FicEd Sample Sample Date Time Sample Preser- # of r <br /> [I3 ttio. <br /> Description Collected Matrix vation Containers (� <br /> e/ <br /> t . 7 4-iKU <br /> --� NIX I <br /> I , <br /> U X19 <br /> __J�j r X 1 ' <br /> X XiX <br /> Qf'Requirement ❑Regular, ❑QA/QC Report; ❑WIP, ❑Raw Data, []Extended Raw Data []CLP, []ACE ❑AFCEE ❑NEESA_(E,C or D); ❑Other.(Please specify) <br /> Sampie Disposal ❑Return ❑Disposal by APCL []Holl for days after receiving date If not specified.,samples will be discarded 45 days after samples are received. <br /> Sample Conditions: ❑Intact; ❑Broken. Couler Seal: []Intact; ❑Broken; ❑ None . Tag # Temperature: ❑ Room ❑/?5 <br /> Cold ( °C). <br /> Relinquished by V Date/Tune + ' ceived byy�✓v���.�r, Date/Time /�� /;CI(?5 <br /> I r <br /> Relinquished by !V} Date/Time ` / Received b/ Date/Time / <br /> APCL " ONLY Service # te: <br /> Cu-nts un and that all terms described to the proposals, quotations for this project, and/or tneral terms rovided in the current APCL price schedules will be followed APCL - -rues the right <br /> _o t..rm its for w_deli:u�y M. if iii's s�retioirms pzo.F bee='• <br />