Laserfiche WebLink
appil APPL, Inc. Phone: (559) 275 2175 CHAIN OF CUSTODY RECORD <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#)-M 14 J U Phone,!;'/O- $P 7-7S';>e'� Company Name C?A?V Y/l C / rcr <br /> Phone: <br /> Address <br /> Address l .'-<, Grc m.1 Ove. , 'S�t *e j rz7V Address <br /> Fax:Sl U- Fax: <br /> S-/o-422-9os 5 y� <br /> Attn: ptaoe SCiYwtle•+r4> Attn: i5ol� tiDyeS <br /> Proj ct Name/Numb Sampl (Print) Analysis Requested/Method Number Date Shipped: <br /> Mer �� � Carrier: <br /> 3 O 3 7 . o . Z%4�A��l.tJ � rc <br /> Purchase Order Number Sampler(Signature) + Waybill No.: <br /> t Comments: <br /> Sample Identification Location Date Time Matrix Number of <br /> Collected Collected Containers <br /> W- 7f2v rvvi<�'i <br /> SAr <br /> C 2ol W-7f/V- 3. (4 `' t o ds h 02 tP Lox,,,, rztb <br /> vV- G N-S.USw �� �� loss` �� S , <br /> 20 W - 2.5Af-S-O.SIAI 030 <br /> 9-o- '2'sw- /V/V-/-1'0 a l( `' 1 a-s <br /> AKIV- 13.S 6 l l 1 S�o J p( D( <br /> . LvM„ typ <br /> Shuttle Temperature: Turnaround Requested: MUS CHECK Sample Disposal: <br /> Standard(2-33 week) a eekQr <br /> 48 hour F] Return to client ❑ Disposal by Lab(30-dayretention) <br /> Reli quished by sampler: Date Timeecei ed b : p t% 0 -Relinquished by: Date Time Received by: <br /> 1" 1�210 J 6 3 > <br /> Relinquished by: Date Time ecei y: Relinquished by: Date Tim Received lab y: <br /> t��y <br /> White:Return to client with report Yellow: Laboratory Copy Pink:Sampler <br />