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CHAIN OF CUSTOL. .3ECORD <br /> appal APPL, Inc. Phone: (559) 275 2175 <br /> 4203 W. Swift <br /> Fresno, CA 93722 Fax: (559) 275-4422 <br /> c.o.c. N° 16427 <br /> PLEASE PRINT PLEASE PRINT <br /> Report to: f�e��,,, Invoice to: <br /> Company Name �"r�-` 14 It L Phones/U ��l' Company Name p2 A7LG ZCZ X� Phone: <br /> Address SS G rv�td , S ZIZD Fax: 6A2_90 >l Address �v >` zc , ` `o� <br /> Fax: <br /> Attn: ip7`Any 5-�,-,��:er o J.10 - � - `l O S'9 Attn: <br /> ro' ct Nam /Numb r Sampler(Print) Analysis Requested/Method Number Date Shipped: <br /> r,.44a,047 Carrier: <br /> Purchase Order Number Sampler nature) Waybill No.: <br /> 1 tComments: <br /> Sample Identification Location Date Time Matrix Number of <br /> Collected Collected Containers <br /> jo-/I-ry 7.erK*x 10/s so; l <br /> -/0 vv-ll <br /> Shuttle Temperature: ;�' <br /> rouRequested: MUST CHECK ONE Sample Disposal: <br /> tandard(2-3 week) ❑ One week ❑ 24-48 hour ❑ Return to client ❑ Disposal by Lab(30-d.yretention) <br /> Relinquis ed by sampler: Date Time Received by: Relinquished by: Date Time Received by: <br /> b/"y l eUv <br /> Relinquished by: Date Time Received by: Relinquished by: Date Time <br /> eceived lab by: <br /> 1pt�3� <br /> White:Return to client with report Yellow:Laboratory Copy Pink:Sampler <br />