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CHAIN OF CUSTODY ncCORD <br /> *Ppl APPL, Inc. Phone: (559) 275 2175 <br /> 4203 W. Swift <br /> Fresno, CA 93722 Fax: (559) 275-4422 C.O.C. N2 17 5 3 0 <br /> PLEASE PRINT <br /> PLEASE PRINT Invoice to: !/ <br /> Report to: CC1`- ,SII Phone: <br /> //? //1 �j�-,2<'J- 2 � Company Name <br /> Company Name Phone: nn <br /> 7 <br /> l �{� �GlT� Address &fg'Vz7 . CO <br /> Address /S S� 6(all S� Fax: <br /> Fax:S!U-K�P'2e ;? i <br /> C9,1 �.o� C'i4 91f 6.2 <br /> ,L,_ 6.22- 70S � <br /> Attn: NI-A 1,114 <br /> Analysis Requested/Method Number Date Shipped: <br /> Pro ect Name/Nu der Sampler(Print) Carrier: <br /> >w r an 2 -ems 111re re <br /> —3 Az' , U1. . � 'a• Waybill No.: <br /> Purchase Order Number Sampler(Signature) <br /> Comments: <br /> Location Date Time Matrix Number of •�' GL <br /> Sample Identification Collected Collected Containers ll_ <br /> -3S w-?SN-1l.L4)13 <br /> rr <br /> -%� In/•- 10,'AI--S'.0 S.W r rc 0�3o rc <br /> --14-0 N.. <br /> Lt/- <br /> • -S.e 10SW-S.v s c✓ <br /> S-. 0W-1oS/V_/0'e; t3 <br /> 4-01,x/ oSw rr �c lws' /r <br /> _ Yv w- UGC M-//.Q r3 <br /> Turnaround Requested: MUST CH CK ONE Sample Disposal: <br /> Shuttle Temperature: q � CC'�►K?x.�l <br /> cI3�(2-3 week) ❑ One ek 48 hour ❑ <br /> Return to client ❑ Disposal by Lab(30-day ratanaon) <br /> Relinquished by sampler: Date Time eceive by <br /> b�{ Relinquished by: Date Time Received by: <br /> S/-5, L <br /> Relinquished by: Date Time eceive ab by: <br /> Relinquished by: Date Time eive by: II/7 <br /> White: Return to client with report Yellow: Laboratory Copy Pink:Sampler r <br />