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i <br /> Opp1 APPL, Inc. Phone: (559) 275 2175 CHAIN OF CUSTOu"RECORD <br /> 4203 W. Swift <br /> Fresno, CA 93722 Fax: (559) 275-4422 <br /> e c.o.c. No 16430 <br /> Report to: PLEASE <br /> I'PRINT Invoice to: �i PLEASE PRINT <br /> i-I <br /> Company Name _ _CK� l L L Phone:S/O-,W- SRF F Company Name Cr1.tM gllz / cc-,- Phone: <br /> Address / S S G r 4�_q , A0vo Address t/ n CD <br /> Ga /� cli� 9L//��•2 Fax:'.'2O- �.2.2 - 90cS'`j Fax: <br /> n ry/a / <br /> Attn: 101<ihe_ Scwwrren S`/U - �2� - �D�6 Attn: cid Iva BS <br /> Project Na�mfe�/tum A S- Sampler Print) Analysis Requested/Method Number Date Shipped: <br /> a S "02:9 02: re Carrier: <br /> Purchase Order Number Samp r(Signature) <br /> Waybill No.: <br /> r t Comments: <br /> 0 <br /> Sample Identification Location Date Time Matrix Number of { <br /> Collected Collected Containers 1 <br /> -_Y0w-0.0 -S.o -Sw •hdtti S G 'moi 0830 7- H <br /> -few- 9.UiV- 3.-i, zz <br /> /r <br /> Shuttle Temperature: Turnaround Requested: MUST CHECK-ONE Sample Disposal: <br /> ❑ Standard(2-3;cek' <br /> e week ❑ 24-48 hour ❑ Return to client ❑ Disposal by Lab ho-day recent—) <br /> Relinquished by sampler: Date Time eiv d y Relinquished by: Date Time Received by: <br /> Relinquished by: Date Timeei d y: Relinquished by: Date Time R ve lab by: <br /> "'IZ4ffow� <br /> : . .White:Return to client with report Yellow:Laboratory Copy Pi pier <br /> I .: <br />