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E n s e c oPage_of <br /> CHAIN-OF-CUSTODY RECORD <br /> SAMPLER: S; 7 /n P) ,p <br /> Date Shipped—/7 2( O Carrier <br /> Phone -7- 77 A1rb111 No. Cooler No. <br /> SHIP TO: SEND RESULTS TO: , <br /> Easeco-Cal Lab Client Name -Yf'V S7 PF_IC <br /> 2544 Industrlal Blvd. Company ._r�?�..e <br /> West Sacramento,CA 95691 ��adar.e. (Z F ely P_T c 7 R cL 5 <br /> (916)372-1393 Lt4� 'T k -17 c-/I -t <br /> ATTENTION: Phone 2 83^ —74:>-'7'-7 <br /> PROJECT NAME SI e�C- n/ PROJECT NO. P.O.NO.Qex 732 <br /> Relinquished y_ i ature) Received by: (Signature) Date Time <br /> Relinquished Signatu e) Received by: (Signature) Date Time <br /> Relinquished by: (Signature) Received at lab by: (Signature) Date Time <br /> Relinquished from lab by: (Signature) Received by: (Signature) Date Time <br /> ANALYSIS REQUEST <br /> Sample ID Sample Date/Time Sample Condition <br /> Number escription Sampled _Sy- Analysis Requested Upon Receipt <br /> u( N 7'PF( -7 45'7 fS <br /> Vow 7 z� 87 cs Z« — <br /> tilt)2 lt� 16'0 )9.7 cl' � <br /> z>< W 2 V v q- � � 1 G' ' 7A-o IS__ <br /> S s � Go 2 <br /> I`7w3 s! rrP{l `? 2a g /6 <br /> V0 -72� (s <br /> 2 xl7W —rt_ Vog -7J2 <br /> -rPt-1 7 z, $ f7''' <br /> W,57- <br /> Special Instructions/Comments: <br /> NOTE: UNUSED PORTIONS OF NON-AOUEOUS SAMPLES WILL BE RETURNED TO CLIENT <br /> Expected <br /> Analytical Immediate <br /> T.A.T's: _ Attention (t00% surcharge) _ RUSH (so-loa% enrcharge) _Standard <br /> — r <br /> Cal Lab ID Number: (for lab use only) <br /> Client Retains White Copy Only (Revved 1/87) <br />