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� Applied P & Ch LaboratoEy Chain of Cus0 <br /> tody <br /> A P C L 13760 Magnolia Avc Chino CA 91710 <br /> Tel. (909) 590-1828 Fax (909) 590-1498 Please Print to pen Page __- of _ <br /> {5E--r-T Contact: KJ'a Tel <br /> ;dt;t.;, _ Fo. BOK 33`l cit4 p <br /> r o p State. Zip code. Z3�7 <br /> ala tort �� 1 <br /> ter- Y pk Analysis ]terns j <br /> l'rt,l— t Name Code + job # P O. White WI.n report <br /> 1'rujrct Address APCL Quotation # H Yeanw - [.ab cope i <br /> DUC Dateegular ❑rush �days _ hours Sampled by: l� � '�- Pink Ort&;-: <br /> ll 11 - a o- <br /> - 1 <br /> I-- I <br /> I I <br /> fFlclii Satrlf:Ie Sample Date Time Sample Preser- of <br /> 11) 10 Description Collected Matrix vation Containers Remarks <br /> 4 <br /> 1 <br /> t I I I <br /> 1071 <br /> f 11 t{ if <br /> ` I I I II <br /> I <br /> r t r it r Ir <br /> M-qk 10 { '! 1{ tt tt 11 41, <br /> QC 14 4uirer. ent ❑Regular, ❑QA/QC Report; ❑WIP, ❑Raw Data, []Extended RaN Data ❑CLP, []ACF ❑AFCEE ❑Iv EESA—(E.C or D), []Other (Please sj•eclry) <br /> Sarnpl+ Disp Osal []Return []Disposal by APCL []Hold for days after receiving date It not specified, samples will be discarded 45 days alter samples are received. <br /> simple C,,nditions- []Int t; []Broken. Cooler Seal: ❑Intact; []Broken; ❑ !gone Tag yp Temperature. ❑ Roorn ❑Cold <br /> Relinquished by .s2 Date/Tittle ! Z—e1Z / 13-b0 Received by } ! Date/Time 0(/2J/0'7 / (3:QQ <br /> LR1111-11111ished <br /> by Date/Time / Received by t Date/Time / <br /> LAPCI' USE ONLY Service # Note <br /> ('}„•i;s un!rrstand that all terms describrd in the proposals, quotations for tht• project, andior the -eneral terms provided In the current APCL pr.ce srhe,tulrs w,ll be followed APCL re.•'rees the r:yr.i <br /> r,' I.r;;,nal err-ice or withhold delivery of any reports, If in APCL'S Sole discretion the trrnii project have heeri brukrn <br /> AV'• ! r,e, • v•• •o, Dei ]o, 1u%. R--,A. 1—JST DAT4 LAnICl14:N.1%UUT TF.W F.,1.'1.s :'ATA t t,AI— l L4 <br />