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A lied P k- Ch Uorator r <br /> Chain of Custody <br /> 13760 Magnolia Ave Ch:no CA 91710 <br /> P C L <br /> Tel (909) 590-1828 Fax (909) 590-1498 Please Print in pen Pagc 2 trf _ <br /> _Vit_n PET ContaTel # [J 7AI?-7 IY6 Fax # MW 24?—/0A/, <br /> Citi': f State �t <br /> -- � Zip code: <br /> � g 7 Ztl Analysis items <br /> lis,Jr.t \ar-.!,Code <br /> 6V1job Qt7. �} White - With -eport <br /> Yro�tct .fid=-ess APCL Quotation # Yel'�ow - Lah co�c <br /> Due Date re ular ❑ amrush: —days hours Sled b ' t <br /> — p Y t Pir.k - Orsg:r.ator + <br /> ��ff V <br /> i l'tt'14 Satn e Sample Date Time Sample Preser- # o{ �I 1 j <br /> i l!) Na I Description Collected Matrix vatioss Containers <br /> I vu 7 _1 S « t 2� Oro 1 I /cf— <br /> -MT91e <br /> �_ji0i <br /> � r <br /> ! <br /> I <br /> I <br /> #11 Met a ' <br /> k <br /> �I i <br /> - -- - ' i t <br /> 11M44 <br /> - ---------I - A IiI 1 1 - 4 ! 1 <br /> r <br /> Qt-H-;virer rnt []Regular, ❑QA/QC Report, ❑WiP, ❑Raw Data, ❑Extended Raw Data []CLP, []ACE ❑AFCE£ ❑NEESA Other <br /> , , Please sprciiy) ; <br /> Sampir Dist=sal ❑Return []Disposal by APCL ❑Hold for days after recewing date If not specified, samples will be discarded 45 days after samples are received.,) <br /> Sample Cc>'-,-Ationsl ❑ln ❑Broken Cooler Seal: ❑Intact; []Broken; ❑ None . Tag # Temperature: [I Room []Cold ( _°C) s <br /> is'-ed by Date/Time 241100 / 13:00 Received by Date/Time O/ zy Cts / U-00 # <br /> Relinyuis':-.ed by Date/Time / Received by Date/Time / <br /> 'APCL t"SE ONLY Service # Note: <br /> C l,rus .ndr- -and that all terms described in the proposals, quotations for this project, and/or th 'nerai trans provided in the current APCL price srhedules will be foHo%veo APCL :. -+rs th, rngttt <br /> I.J.- r,:,i ,ervsce or withhold delivery of at.y reports, if in APCt_'s sole discretion the term~ pr.j,,-% have l,rru l,r,•lcn <br /> v.. 4 a. D- 30. 1%v4 ate..,-..,.irncr n.T. , .,., ... . u..nr-r.. .-,.,. . .,.r• -�„ ..• .. <br />