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WORK ORDER AP <br /> CHAIN OF CUSTODY RECORD <br /> Alpha Analytical Laboratories Inc. • 860 Waugh Lane,H-1,Ukiah,CA 95482 • (707)468-0401 FAX(707)468-5267 DATE �9'9`�' PAGE _L OFA_ <br /> CLIENT'S ME PROJECT MANAGER SAMPLE CONDITION ON <br /> vvy'd ,c�.d !C/Y .�+i r4 G. / RECEIPT: <br /> STREET ADDRESS CITY STATE ZIP PHONE NUMBER <br /> COLD/ICED? <br /> PROJECT NAME FAX NUMBER G <br /> BUBBLES OR AIR SPACE? <br /> CONTRACT/PURCHASE ORDER/QUOTE NUMBER SITE CONTACT y <br /> WERE SAMPLES PRESERVED? <br /> SIGNATURE OF PERSON AUTHORIZING WORK SAM P BY <br /> UNDER TEAMS STATED ON REVERSE SIDE OF <br /> T -ORM. d <br /> WtAMPLE NUMBER/IDENTIFICATION DATE <br /> • • <br /> ..� r , <br /> _•.�. v. E. 3,b ;}.! f 1 ,i' to I• <br /> ` s C',;i 1{s is,i�„-"•� a <br /> t.J. ". ... vl s +.w�vsak,� "�y. t-+•' -.� .t i f.y.• . • . =�R• .�: T'.ilk t��.M 1 t.., ,.F .r" f•., <br /> s _ 5 ✓ <br /> E - `' }axe F'. _} ';.ik.�l. .,♦ — ' 'E..N .i.. .[. I _ - '�.V� • �• _� <br /> •.t, .. :�. /�i��Dl�.n+ 4., r ..�" t� z'�: ., , ,y:: x. .w. ,'r'��.EQi(`t ,. <br /> Js" in <br /> WIRN <br /> ED RECEIVED BY: DATE TIME •• REQUESTED <br /> (SIGNATURE) Ile <br /> MHE 0,Q_Y RECEIVED B DATE TIME <br /> '(SIGNATURE) (SIGNATURE) +�•�f <br /> RELINQUISHED BY: RECEIVED FOR SAMPLE C ROL 0 , <br /> (SIGNATURE) LABORATORY BY: <br /> METH(4)OF SHIPMENT AUTHORIZED BY: SAMP ESPOS ION: <br /> I. STORAGE TIM REQUESTED DAYS <br /> (SAMPLES WILL BE STORED FOR 30 DAYS WITHOUT ADDITIONAL CHARGES: <br /> SPECIAL INSTRUCTIO THEREAFTER STORAGE CHARGES WILL BE BILLED AT THE PUBLISHED RATES.) <br /> 3?,•ems ff&4du 2. SAMPLE TO BE RETURNED TO CLIENT? ❑YES ❑NO <br /> DRIVING TIME SITE TIME TOTAL TIME HAZARDOUS MATERIALS ARE THE PROPERTY OF THE CLIENT.THE CLIENT IS <br /> RESPONSIBLE FOR PROPER DISPOSAL OF HAZARDOUS WASTES.CLIENTS NOT <br /> Q J dm PICKING UP HAZARDOUS WASTES MAY BE ASSESSED AN APPROPRIATE FEE. <br />