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CHAIN OF CUSTOD,, RECORD <br /> Opp APPL, Inc. Phone: (559) 275 2175 <br /> 4203 W. Swift <br /> Fresno, CA 93722 Fax: (559) 275-4422 <br /> c.o.c. N° 17538 <br /> Report to: PLEASE PRINT Invoice to: PLEASE PRINT <br /> Company Name � � �� Phone:S/L- �zS/- 2L d�� Company Nam//ee� �'jAPI P U C z CC.� Phone: <br /> Address lss G� vim• 3 SfttfC�lrDn Address `JR41l/R-n Cy <br /> Fax:Sl U— �,�.2— 70'7,,/ Fax: <br /> Volttn: Y�/G✓v1? SCi.+rVn�Pmt ria Attn: f bB t9t°S <br /> �Pr ject Name/Number Sample Print) Analysis Requested/Method Number Date Shipped: <br /> r�cm 5��� �'1/J Carrier: <br /> C)/ / l Ptd tr <br /> Purchase Order Number Sampler(Signature) Waybill No.: <br /> f Comments: <br /> t <br /> Sample Identification Location Date Time Matrix Number of � 4 <br /> Collected Collected Containers T, F <br /> _ IV mo w_ 9//V-S.o S ll�,� C'P30 -5011 <br /> - o.d w-. SOAl o w Gt d 0 /d !c / S� <br /> Sow- 2.001-0/7.0 Sw It ,t a t ( I X <br /> tc <br /> .0 W .Z.o&-6-.o Sw l c 0720 t, I S,�t.aL <br /> -S.oLu- 73N- la-C) /3 tc It oso `c l p( V- <br /> a t pC 37 <br /> Shuttle Temperature: Turnaround Requested: MUST CHECKN o2#�-., - S2L� � '-s Sample Disposal: <br /> r <br /> Standard(2-3 week) On w ek 0 24-48 hour ❑ Return to client ❑ Disposal by Lab(3"ayretenion) <br /> Relinquished by sampler: Date Time ceive by sL Relinquished by: Date Time Received by: <br /> elinquished by: Date Time eive by: Relinquished by: Date Time Received bb <br /> 0- N)"� X80 <br /> White:Return to client with report Yellow:Laboratory Copy Pink:Sampler <br />