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CAL- NCE-ENJRG NTAL � -�E C ll-1 /ono• <br /> - GWE9 f4C„q— CHAIN OF CUSTO&ECORD <br /> 7448-UIICOL`14 WAY <br /> Date <br /> GARDEN-GROVE,-GA 92841-1432 <br /> TEL (714)-OR5-&494_-0-F-A,?4,47-14)-B94-7501 Page of 1 <br /> LABORATORY CLIENTCLIENT PROJECT NAME 1 NUMBER PO NO <br /> v S C o r o rd- i c�r, '- 5-x-0 c.�--ov,' <br /> ADDRESS r g <br /> SLE-10 0. 0. ocLKS Dr. 5 V J0 d PROJECT CONTACT LAB USE ONLY <br /> CITY STATff ZIP C4. Kir )6 -6-7q 07(o 11 El - ❑ ❑,❑ ElM YYl'e n�-o G A q- p�p 3 3 SAMPLERSiGNA URE <br /> (S) ( ) COOLER FtkEIPT <br /> TEL FAX E-MAIL <br /> q 1 -6--19 -a a o 0 9 r -61q -a q;W7 TAMP= �c <br /> TURNAROUND TIME ,���� REQUESTED ANALYSES <br /> ❑ SAME DAY ED 24 HR El 48 HR El 72 HR ❑ 5 DAYS Ll�10 DAYS <br /> SPECIAL REQUIREMENTS(ADDITIONAL COSTS MAY APPLY) m <br /> ❑ RWQCS REPORTING ❑ ARCHIVE SAMPLES UNTIL <br /> 0 o ca .� <br /> C7 <br /> O <br /> SPECIAL INSTRUCTIONSJ W Q Cookers <br /> S <br /> Sin r p rm en} has <br /> Lff C1,. c o sn ~ <br /> C14 co <br /> QS co � a o Ln <br /> — z no c� c F- CN <br /> m CD <br /> m o ter. cv - 5 o <br /> r C/] <br /> c ~ N o aNYo © p m ch CD z Q <br /> GJ G C-;) ls7 y 06 a0 F; Lo <br /> LAB C3 N y CJ N ti N 0 <br /> USE SAMPLING xa os = s axis � c) W o vs cD m cj a U a w <br /> SAMPLE ID LOCATION/DESCRIPTION MATRIX � a F a CD o } LU U 0 a 0 o z x <br /> ONLY DATE TIME CONT F" t" CL w v d_ :z. Lj <br /> -1-0I !t to °'? a- <br /> D W 3-1-o I (V go O-S a <br /> +MW -1 o-1-0 it ?jL0 '0 ag 3- <br /> DMW - 10 -o I 1)-30 i-g <br /> bM W - b © 3.-1-01 j a35 cL <br /> aNvJ - -5 3-I -a I IaH& 0-� <br /> Dt4 1350 <br /> 3-1-o I 'ma s M5 D <br /> Ri wish d by (Signature) Received by (Signature) Date Time <br /> 3_1 -0 ! 16"50 <br /> e6quished by (Signature) Received by (Signature) Date Time <br /> a <br /> m i <br /> Relinquished by (Signature) Received for Laboratory by (Signature) Date Time U <br /> d <br /> DISTRIBUTION White with final report,Green to File,Yellow and Pink to Client 10/01/00 Revision <br /> Please note that pages 1 and 2 of 2 of our T/Cs are printed on the reverse side of the Yellow and Pink copies respectively <br />