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CHAIN OF CUSTOD k RECORD <br /> appil APPL, Inc. Phone: (559) 275 2175 <br /> 4203 W. Swift <br /> Fresno, CA 93722 Fax: (559) 275-4422 <br /> c.o.c. No 16430 <br /> RepQrt to: n PLEASE PRINT Invoice to: PLEASE PRINT <br /> Company Name C�o� -( /I L Phone.SSU-,ZS/- Company Name C? -W AML e� CC.r Phone: <br /> Address f S S G raM a� 1A%f10VV Address �,V� Co <br /> t/ C,, 21/4-/Z <br /> Fax:5/0— 6.22 — 90�s 9 Fax: <br /> Attn: JOlah,P- U - ea.9- ''0;7 Attn: Ajay&S <br /> Project Name/Numl�erf� Sampler(Print) Analysis Requested/Method Number Date Shipped: <br /> -7-1�T J S / "1079 re Carrier: <br /> Purchase Order Number Samp r(Signature) ti N" Waybill No.: <br /> T,i f Comments: <br /> o <br /> Sample Identification Location Date Time Matrix Number of <br /> Collected Collected Containers <br /> o o 0 ooPp rs <br /> � 711W-o.D�-S.0 -St..l �hday, S �/ 8.30 .,;L � Q( <br /> iI <br /> -YOV- 3 -I't 613 <br /> Shuttle Temperature: Turnaround Requested: MUST CHECK-ONE Sample Disposal: <br /> ❑ Standard(2-3 week) E I a week ❑ 24-48 hour ❑ Return to client ❑ Disposal by Lab po-day retentlon) <br /> Relinquished by sampler: Date Time eiv d y Relinquished by: Date Time Received by: <br /> Relinquished by: Date Time Ri6cei d y: Relinquished by: Date Time R Ive �fClab <br /> White:Return to client with report Yellow:Laboratory Copy Pi pier <br />