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CHAIN OF CUSTODIRECORD <br /> appil APPL, Inc. Phone: (559) 275 2175 <br /> 4203 W. Swift <br /> Fresno, CA 93722 Fax: (559) 275-4422 <br /> c.o.c. N° 17 5 2 9 <br /> Report to: / PLEASE PRINT Invoice to: PLEASE PRINT) <br /> Company Na>mec ( y//< </� Phone:-Szo — SD">-�5�� Company Name C/� ��� / �C� Phone: <br /> Address ///✓ s /�nJt �V�'z°- u �p//lam Address C <br /> &,7C.6� O/� Fax:S/(J— G��—NQS' Fax: <br /> Attn: 7 aM�_ SGi.+'t�+ 2. d /74��Lf%*?? 5/19 �r - �D 7! Attn: VSO f9 &ly^1e2f <br /> �,t Narpe/LNunlf�el ,� Sampler(Print) Analysis Requested/Method Number Date Shipped: <br /> 7�Av 3D>IV 6/ 7 ,4 (Z� Carrier: <br /> Purchase Order Number amp Signature) - Waybill No.: <br /> A Comments: <br /> I f <br /> Sample Identification Location Date Time Matrix Number of �1 <br /> Collected Collected Containers <br /> )O- 2 W- VAJ- J,2.S13 o1�9/ v8/0 Sa'( f DC X ')y14 C, <br /> �- �f2L'/ S.o S l /1st I OC S <br /> -/v S'1 /r rf lass N / DC <br /> y <br /> Shuttle Temperature: Tumaroun equested: MUST CHECK ONE Sample Disposal: <br /> Standard(2-3 week) ❑ f One week &(-2)-48 hour ❑ Return to client ❑ Disposal by Lab(30-day retention) <br /> Relinquished by sampler: Date Time ei d y: (p ti^ Relinquished by: Date Time Received by: <br /> a�yli�ry 1 s, <br /> Relinquished by: Date Time R ceiv by: Relinquished by: Date Time Received at lab by: <br /> i o/3b/off moo <br /> White: Return to client with report Yellow:Laboratory Copy Pink:Sampler / <br />