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CHAIN OF CUSTODY J4ECORD <br /> MAPS APPL, Inc. Phone: (559) 275 2175 <br /> 4203 W. Swift <br /> Fresno, CA 93722 Fax: (559) 275-4422 N2 17 5 2 9 <br /> C.O.C. <br /> Report to: PLEASE PRINT Invoice to: PLEASE PRINT <br /> p //�� <br /> Company Name C� ///y Phone:5'10 — S87-�S`�� Company Name C/f "P/l � Z (-C'-2— Phone: <br /> Address 15s'/G��1 t/ ',P^PAddress —ALe#'K/z4 <br /> Fax:.S/(J— <br /> Fax: <br /> Attn: 710t2 2_ SGti✓1.+ l4� '-P Attn: Vats 4 <br /> etotect Na //`Nun* Sa&Ir t) Analysis Requested/Method Number Date Shipped: <br /> A/f ` _ Carrier: <br /> Purchase Order Number anature) �U�P Waybill No.: <br /> Comments: <br /> I � I <br /> Sample Identification Location Date Time Matrix Number of <br /> Collected Collected Containers l <br /> 09/0 C4 <br /> tZo- 'f��✓- 7�4v-S.o S / n P <br /> �Sw -7,2/v- 12.66 /< Ir X225 �� / //y:•., <br /> �Ykr <br /> Shuttle Temperature: Turnaroun equested: MUST CHECK ONE Sample Disposal: <br /> Standard(2-3 week) ❑ One week &12 -48 hour ❑ Return to client ❑ Disposal by Lab(ao-a.Y retentlon) <br /> Relinquished by sampler: Date Time ei d y: Relinquished by: Date Time Received by: <br /> o�yj�y 1 S, <br /> Relinquished by: Date Time R ceiv by: Relinquished by: Date Time Received at lab by: <br /> `�3b�o� mooWhite:Return to client with report Yellow:Laboratory Copy Pink:Sampler <br />