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M <br />=z <br />i� <br />MzMZ <br />nM <br />MZ <br />Z39 <br />r <br />UNITED PUMPING <br />0 - 'C� D-0-7 f <br />6102A' <br />SERVICE, INC. r <br />AN ENVIRONMENTAL REMEDIATION FIRMffm <br />FOR LABORATORY USE ONLY <br />CERTIFIED - STATE APPROVED r Laboratory Project No. Secured & !;? <br />Storage Refrigerator — Yes <br />CHAIN OF CUSTODY RECORD <br />( Storage Freezer ID: No <br />Ir <br />Project Name: Project #: Jar, ✓' a pier: r . <br />Sr. <br />AX <br />Relinquished by: (slgnarura ar,d Pared r�a�l � ; � � Received by ;a:gnaa,•a aid Prinrad Name) Date:,- Time: <br />Relinquished bv: (Sionawre and Pr 1.d Na +1 h' _ / Received bv: is—t—andp,_ Ti nF <br />Relinquished by: (signature and Pdrned Name) Received by: (sgnat ­ M Primed Name) p % � Date:� J Time: <br />Relinquished by. (signature and Pnrned Name? ReC0lved by. (s gnaw•a and Ped Name) :� r elr� fi i, Date �� Time: <br />SHIP TO: Method of Shipment: Circle or Add OU, <br />UNITED PUMPING SERVICE INC Analysls(es) a) Identify specific metals <br />14000 EAST VALLEY BLVD. \� ��' 1 <br />Requested Jo a` G 1 G requested under pedal <br />CITY OF INDUSTRY, CALIFORNIA 91746 <br />PRONE: (626) 961-9326 Shipment ID \� J C9 e� C� eG� ` Instructions <br />FAX (626) 336-7734 p G, P`Y O� C? G1 a a � <br />FAX (626) 961-3799 <br />www.uniled mv�in om \� �O ,CQ Q,5 C1P �\a F1P Q\� j) rD \Q' �,'C` � tjJ $;• <br />d <br />CD <br />CD <br />(O <br />O <br />fV <br />O <br />-, i <br />m <br />CID <br />1.- <br />010 <br />rV <br />Sample ID <br />NUmber <br />Sample Description <br />rte■■■ <br />■■■■■■■■■■■■■■■■■■■■■■��� <br />------------- <br />mom■■ <br />■■■■■■■■■ �� <br />2. <br />!r[ <br />rr, <br />CD TAT Anal tical Turn Around Times 1 = 24 hours 2 = 48 hours 3 = 1 week 4 = 2 weeks <br />�) s�mp(e Archive/Disposal: ( Y ) <br />i� S nstuctions Comments �(i� Grr�i1 ^ Container T oes: B -Brass Tube. V=VOA Vial, A -1 -Liter Amber, G=Glass Jar, C ' <br />� aboratory Standard Y - �' sette, <br />Other <br />O - Other <br />SEND DOCUMENTATION AND RESULTS TO (Check one). ? <br />_..........manager/office: <br />_ �- ,Project _����� •�'� <br />FOR LABORATORY USE ONLY. Sample Condition Upon Receipt ❑ Clent Name: qty <br />7 Company: I'`I <br />N) M <br />O <br />a Address: <br />Phone: Fax: <br />;'jai <br />