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CASA ANALYTICAL LABORATORYzA g CHAIN OF CUSTC& <br /> Location 2333 Shuttle Drive, Bldg 9081909, Atwater, CA 95301 Certificate No 2079 <br /> Mailing Address 2333 Shuttle Drive, Atwater, CA 95301 PAGE I OF <br /> Phone 1209) 384-2930 - Fax (209) 384-1507 <br /> Customer 11atV iar[ Lir a S211YI REQUESTkQ ANALYSES Method of Shipment <br /> Address- q00 S tinct{ 1a i U c, m �, it <br /> City/State/ZlP { a o Z 10462 <br /> Phone / FAX "a ~ J a ' <br /> Pro) # I P O # r l J� � w UJ <br /> Report Attention 8 a " = a o <br /> Sampler Signature a g S m m ; 10464 <br /> Printed _h <br /> Z C <br /> Lab 1D# SAMPLE ID DATE TIME DESCRIPTIONILO CATION ; 10465 1 0 4 6 5 <br /> M I )I qel5 ti <br /> 10466 <br /> + - 10467 <br /> �,► 10466 <br /> 10469 <br /> 10470 <br /> + , <br /> + 10471 ; <br /> }� <br /> 10472 <br /> 10473 <br /> T , + to <br /> Sigi,iatUre Printed Name Date Time Company Name 10 4 74 <br /> Relinquished b ] ( ►J S S ��> Notr. ck <br /> Received b 1�:G� S"615 9'36 C tum times)must to cleared through <br /> Y k Pu aauthorized laboratory personnel <br /> Relinquished/by <br /> Received by <br /> Relinquished by <br /> RESULTS DUE <br /> Received by GOOD{�UIYDITIADODn j Lj <br /> ON <br /> VERBAL WRITTEN <br /> A E ABSENTHEAKP -4CCONTAINERS <br />