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CHAIN OF CUSTODY ..CORD <br /> Np <br /> APPL, Inc. Phone: (559) 275 2175 <br /> 4203 W. Swift <br /> Fresno, CA 93722 Fax: (559) 275-4422 <br /> C.O.C. N° 17530 <br /> PLEASE PRINT <br /> ry —7 <br /> Report to: PLEASE PRINT Invoice to: <br /> C 2 S Company Name C'C� C/ � /l Phone: <br /> �� <br /> Company Name Phone: /D—,2C)'Z <br /> 1Ss <br /> Address Grp Sud lam - � � <br /> Address Fax: <br /> Fax:S!U-�2 0�— 4 7d <br /> s iv- 64,2-qos 9 <br /> Attn: <br /> �)tt.>,+e Sanry Attn: <br /> Sampler Print Analysis Requested/Method Number TaShipped: <br /> Pro'ectrN�e3/`Nur9�e�r -� p (Print) <br /> y�� er:/ Z�9 re bill No.: <br /> Purchase Order Number Sampler(Signature) ments: <br /> T� , <br /> Sample IdentificationLocation Date Time Matrix Number of <br /> Collected Collected Containers <br /> -3s w-?SAI 0 6 Mkh <br /> tr <br /> r c u o 93r� `L L !�*• <br /> ww loP�v-S.v si✓ <br /> rc -5&.jZ <br /> << u fK <br /> 10 AJ-- S.osw dd*b � <br /> .- ao W- 9SN !>0 �- <br /> -Sow-las�v-.�.vsc✓ tt <br /> 4-ow -l0_.! eAr-6.osw 2Y <br /> haw- UD N=11,Q <br /> Shuttle Temperature: Turnaround Requested: MUST CH CK ONEyet Sample Disposal: <br /> kcL_ <br /> 3 week) ❑ <br /> One ek 48 hour E] Return to client ❑ Disposal by Lab(30-day retention) <br /> Relinquished by sampler: Date Time eceive by' <br /> (� 6�{ Relinquished by: Date Time Received by: <br /> Max s,s C <br /> Relinquished by: D�(e Time eceive a by: <br /> Relinquished by: Date Time eive by: 11/ <br /> White:Return to client with report Yellow:Laboratory Copy Pink:Sampler <br /> rp li-5-01 <br />