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CHAIN OF CUSTOD, r;ECORD <br /> OPPIII APPL, Inc. Phone: (559) 275 2175 <br /> 4203 W. Swift <br /> Fresno, CA 93722 Fax: (559) 275-4422 <br /> C.O.C. N° 17531 <br /> Report to: PLEASE PRINT Invoice to: PLEASE PRINT <br /> Company Name �? 9 /�/ Phone:S/0•., &/- 2,F73 Company Name Gq)PI Phone: <br /> Address 1/� -! it .�aC � � i _bona— Address_ Lp'mV.p t <br /> Fax: S/,a -- �- �SS" Fax: <br /> Attn: Attn: 6-01 <br /> Prq�ect Name/Nue Sample,,(Print) y� Analysis Requested/Method Number Date Shipped: <br /> j v A_e'w / "C ooy;e Carrier: <br /> Purchase Order Number Sampler(Signature) h, Waybill No.: <br /> q,p Comments: <br /> Sample Identification Location Date Time Matrix Numberof <br /> Collected Collected Containers <br /> -JLIVV-//,3 N-S.0 s w 7 S 111?Af has• So,' ' 1 D� <br /> Shuttle Temperature: Turnaround Requested: MUST CHECK ONE ��� Sample Disposal: <br /> ❑ Standard(2-3 week) ❑ O e week 2 48 hour ❑ Return to client ❑ Disposal by Lab(3o-dey retention) <br /> Relinquished by sampler: Date Time c 'ved y: �,I�� Relinquished by: Date Time Received by: <br /> Relinquished by: Date Time cei d by: Relinquished by: Date Time Received at lab by: <br /> t -g-01 1, <br /> . 1,T'.551- pc' q-� <br /> White:Return to client with report Yellow:Laboratory Copy Pink:Sampler <br />