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THE TWINING LABORATORIES INC. Project Name <br /> 2527 Fresno Street, Fresno, CA 93721 f(209) 268-7021 Address <br /> ate Chain-of-Custody and Analysis Request Record Mgr. <br /> TL# <br /> Age--- 4--of--�--_ <br /> Analysis Requested <br /> eport To: Copies To: I ! ! <br /> fienl Name ( ' Lab <br /> Due <br /> ddress Date <br /> Expected Turnaround: <br /> ontact Name I <br /> ❑ Rush El Routine <br /> lone r <br /> ontract/PO# Specify Time <br /> ampler Name 11 FAX# <br /> (Prim) <br /> rb Client Sampple Sample l <br /> 1M Sample Ip Date/Time Type M/Size/Type of Container Preservation/Handling: <br /> tie <br /> �,. <br /> I <br /> we .� <br /> . i <br />=aV h hazardous sample submitted For Water samples,please Comments: (BILL TO IF OTHER) Dept. Initials Date/Time 1-ocation <br /> or analysis will be charged a hazard- check one of the following: 601 <br />)us waste disposal fee. Clients that ❑Drinking Water — <br /> etrieve hazardous samples within 30 ❑Waste Water 602 <br /> lays of the analytical report date will ❑Ground Water(wells) 603 <br /> ie refunded any disposal fees. ❑Surface Water(rivers,lakes) 604 <br /> elinquished Py: Delivered By: Received By;. Received By: <br /> ignature �:f� �y ? Signature Signature �'' ✓� Signature <br /> ranted . ��- r r; Printed Company Company <br /> ompany Company Date/Time - -2 <br /> Date/Time <br /> ate/Time f! Date/Time Log In Date/Time Log In Date/Time <br />