Laserfiche WebLink
CHAIN OF CUSTOD t.tECORD <br /> oppl APPL, Inc. Phone: (559) 275 2175 <br /> 4203 W. Swift <br /> Fresno, CA 93722 Fax: (559) 275-4422 <br /> c.o.c. N° 16431 <br /> Report to: PLEASE PRINT • Invoice to: PLEASE PRINT <br /> Company Name C#P-M N I« Phone. /O -;>S 7,4' Company Name Cfl PI R11 L r Phone: <br /> Address /S)S �raMo� Ove_ cS,Ltl fe 1077V Address be.., V.0" Cd <br /> 0-74 C'4 C'4 gfcf%y Fax:S/O- G�- 9O?t ' Fax: <br /> S'/0-G22-%,P s 5 <br /> Attn: <br /> A I�e S4 r PO ^1rT> Attn: <br /> Proj ct Name/Numbn Samplpf(Print) Analysis Requested/Method Number Date Shipped: <br /> Carrier: <br /> 3 0 3 7 . a . S �G'G.� l,✓ �v� rc <br /> Purchase Order Number Sampler(Signature) + Waybill No.: <br /> t Comments: <br /> Sample Identification Location Date Time Matrix Number of t� <br /> // Collected Collected Containers <br /> - �`I W- `t/- 3.S 7�.v r►vF�-r 9$ a o�23 � ! � r, �.u., P�-,d <br /> iL/W-]gni- 3.� `' toffs <br /> W - tN-S.6S (( t` llco <br /> Al-/3.0 a I (i I' f <br /> o - 2 S w- a6iv- 3.s 6 c` ` I s�o D� t. LUIA <br /> L'441 Ae S <br /> C <br /> Shuttle Temperature: Turnaround Requested: MUST CHECK ONE rSample Disposal: <br /> Standard(2-3 week) C ,q a eek 48 hour Return to client ❑ Disposal by Lab lao-day rets fio„) <br /> Relinquished by sampler: Date Time ecei ed b : (0 t% 0 elinquished by: Date Time Received by: <br /> f9,flo 16 3 > <br /> Relinquished by: Date Time vRecei ;Ly: I Relinquished by: Dat/ Time me R t lab <br /> XV White:Return to client with report Yellow:Laboratory Copy Pink:Sampler <br />