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CHAIN OF CUSTODY APPL, Inc. <br /> RECORD 4203 W. Swift Avenue, Fresno, CA 93722 <br /> Phone: (209)275-2175 <br /> Fax: J209)275-4422 <br /> Project Name/Numbberr Sampler(Print) Analysis Requested/Method Number Date Shipped: <br /> 4-)tJQ,� Q Carrier: <br /> Purchase <br /> aseOr tlu� Sampler(Signature) <br /> Wa l No.:®, _� �'[ � � <br /> Comments: <br /> v <br /> Sample Identification coa ti.Ud Collected Matrrc diner. <br /> l,Z 0,s �r 141b 5 <br /> ,gTI--Is Ask(-/4 ./c,./„d l <br /> Shuttle Temperature: Tumaround Requested: Sample Disposal: <br /> ❑ Standard(2-3 week) ❑ one week ❑ 2448 hour ❑ Retum to client ❑ Disposal by Lab po•dey ratendoni <br /> by pier:7 lDa Time Receiv by Rel wished by. Date Time Received by: <br /> ?.'if jj 4-w'-. S <br /> R stud Date Time Received by. Relinquished by: Date Time R ived at la 17,-1 <br /> 12:0= <br /> 'g&a <br /> R o: <br /> Pollutants Laboratories, Inc. Bill to: <br /> 4203 West Swift <br /> Fresnoi GA 93722 Agriculture & Priority <br /> Pollutants Laboratories, Inc. <br /> Phone*: FAX#. 4203 West Swift <br /> White: Return to client with report Yellow. Laboratory Copy Pink Sampler PrepnQ. <br /> CS 010993 c.o.c. N° 2648 <br /> City of Stockton 190855-0OO6 <br />