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N A L Y T I C(A.�', <br />19 <br />rpm LABORATORIES <br />1414Stanislaus Street Fresno, CA 93706 <br />(209)497-2888 FAX 185-6935 800877-8310 <br />Me C' sir <br />Analyses Request Chain of Custody 9805000274-WESTSTAR-ENV <br />7 7- )j'7t <br />Sign re <br />Print Name <br />Cornpany <br />Company <br />Date <br />Time <br />Requested I RelloquisbW by: <br />-C, ]Zr ki. "p, <br />SIP If( <br />r'O <br />R9o*sd1R*lhM&bvd by: <br />RevelvediltelhRul6od by: <br />Addnre 6 q, q FAX N -2. -7 7 • e) <br />Cky'sime'ZIPCry to-. 47,bp <br />ry-,e o 4- SYS am# <br />Realved f Relloqubbed br. <br />Date <br />Sampled <br />Tin" <br />Sampled <br />qwMW br. <br />- ,/,, - <br />Y go <br />Comment or <br />Station Code <br />Sample DescriptionfLocation <br />2-, W,4 te 3, <br />q <br />3" 'P -3f e 3 <br />M <br />1( <br />k <br />9 <br />2, <br />6 <br />MaInX J Ype: L - Liquid 5 - Solid 0 - Gas Additional Services: Additional Services Authorized by: <br />Type of Hazards Associated with Samples: Rush Priority: I 1- 2 Day [ 1.5 Day <br />Formal Chain of Custody I - QC Data package <br />Sign re <br />Print Name <br />Cornpany <br />Company <br />Date <br />Time <br />Requested I RelloquisbW by: <br />-C, ]Zr ki. "p, <br />SIP If( <br />R9o*sd1R*lhM&bvd by: <br />RevelvediltelhRul6od by: <br />Realved f Relloqubbed br. <br />