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CHAIN OF cus-roEcoRu <br /> 74 AY Date 3 I <br /> 841-1432 r <br /> TEL l7iA1 AOF FICA env T�h� Qn4-7501 Page of <br /> LABORATORY CLIENT Ij p C ` CLIENT PROJECT NAME!NUMBER PO NO <br /> F J i3 C0.�l O rl <br /> ADAF p- s+-s+-,-Mc <br /> L <br /> DR 5�57 <br /> �Q �,� Qq S ��_ �C 1� PROJECT CONTACT LAB USE ONLY <br /> c€TY �nerti G{ r 9 IP <br /> JaC L �McZ l b-b�9-,40-1(� ❑ ❑ - ❑ ❑ ❑ ❑ <br /> TEL FAX EMAIL 5A LER{S) {SIGNATURE) COOLER RECEIPT <br /> q 1� -- 61� - -1b M1516- V7" �� � TEMP= ac <br /> TURNAROUND TIME REQUESTED ANALYSES <br /> El SAME DAY 1124 HR El 48 HR El 72 HR ❑ 5 DAYS Ly'/10 DAYS <br /> SPECIAL REQUIREMENTS (ADDITIONAL COSTS MAY APPLY) cg <br /> ❑ RWQCB REPORTING ❑ ARCHIVE SAMPLES UNTIL o m <br /> SPECIAL INSTRUCTIONS `W m <br /> H <br /> Sh pmex.k KCLS +wo c�r�tzrs m <br /> N o [p o <br /> N CO O Cn <br /> Q H <br /> 1.0 L0 <br /> OO Cn p C3 N_ N <br /> w Q CO O Q �00 E37 W C= W <br /> Cn 'm CD C7 M I -- — N CL 2 G cn <br /> o I- � N O C'4C7 O C-) N M O Z Q <br /> 4 a0 ao C7 o? H H C7 <br /> LAB ~ © v, CJ h y ~ co ~ o <br /> SAMPLING NO OF � J C] U C7 Cn M C7] V Q U - w <br /> USE SAMPLE ID LOCATION/DESCRIPTION MATRIX a s �- a o o w v p a z o s x <br /> ONLY GATE TIME caxT H i— co > > en C>. a- w c] a C..) u. <br /> dU3 -[ - t I ;L-Q 0-,t, �- <br /> t�1 vv I dU? -3-1 - o t !2 0 G `-t <br /> oeCl 3-1-0 ► I2-3U "- <br /> j(.�Uv - U Dor 3 1--o i 11-1 !5 z - <br /> �11n; 11090 3-I-o t 1-14 (--% <br /> t-� f -I-o t 13Sa <br /> Dkw <br /> Reli quish d by (Signature) Receiv ignatu e) eve Time <br /> %110 3,ADe <br /> I(Le4dquished by (Signature) Received (Signat Da Time <br /> i V <br /> X <br /> f I ¢ <br /> A <br /> Relinquished by (Signature) Received for Laboratdry by (Signature) Dale Time <br /> a <br /> a <br /> DISTRIBUTION White with final report Green to Fite Yellow and Pink to Client 10101!00 Revision <br /> Please note that pages 1 and 2 of 2 of our T1Cs are printed on the reverse side of the Y w d Pink copies respectively <br />