Laserfiche WebLink
d <br />m <br />r -t <br />m <br />A <br />N <br />m <br />m <br />W <br />IS) <br />A <br />I <br />— DeMerno/Kerdoon <br />z�cri.c nc- For ACleaner E•,virowent <br />2000 Norin AlaT eda Slreet • Comp'or CA E0222 <br />537-710,; Fax 1101 633 2?46 . . <br />Ot 1� PLAP :20337 <br />11 1103fl� <br />Chain of Custody <br />O <br />O <br />c -4 <br />Client: UPlZ12 s--f'bG{� ►/� Contact: ee, 'el, Tei��lD) G �� Ft 73 <br />Address: 4,� City: State: Zip Code.�� ZoCp <br />Project Name: �� �t—L 2G � Sampler(s) Signature:il, Gow <br />�- /` /p-,c)v-,4 Qv- � i I <br />r-_obii Vlanaaef: iir -7 %i4VIAJ�.v <br />�'_Z ., w <br />V ✓ii V rvr 1 G b -s <br />__X� 5 -en, fx, <br />Sample Description <br />Lab <br />ID <br />Date Time <br />Collected <br />Matrix <br />No. of <br />Containers <br />Analysis Requested <br />T P <br />Z) K_ <br />tt, i o3 <br />I In <br />t o <br />3 <br />'�'I!L G AA _-s- <br />e, e, <br />Cs . <br />STS' 1�;e� Z► <br />Z T 0 G 2 <br />1::::'- <br />II it DS <br />1010 <br />Si"'L-trJ <br />3 <br />- ��G��1 <br />�v✓os��/t �y <br />z,r� �-r 1 �-t,✓s <br />l/_l s o3 -o 7 <br />/ � ! U3 � d <br />j <br />r�-��s <br />>' <br />i� ►�t t 47,,b <br />_ <br />} u f/� -�--i I -f-�✓ � <br />I <br />'�7 �- {tom S <br />i l 41-) <br />— — <br />Sample Conditions: Seal <br />Relinquished by (Signature) <br />Relinquished by (Signature) t <br />Intact j Broken bj None; Temperature ,J Co Room; Oth <br />S <br />4;,-"64467__ Received by (Sietrature) y� telTime hi t t f �3 3t y\ <br />Received by (Sigralure) DateiTime t u 3 S "3pf,, <br />Lue-S, <br />RPRP11/Prl hV Minnat11ra1 Date'Time <br />SPECIAL INSTRUCTIONS47 <br />,e,Am &o!5? Ave, IQ o tel" p VPS y -- <br />WHITE COPY—Client PINK COPY— Courier Page _ of <br />