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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: (209)2754422 <br /> Project Name/Number Sampler(Print) Analysis Requeste&Uethod Number Date Shipped: <br /> Li -AEt, Carrier. Fete ,u� ' <br /> Purchase Order Number Sampler(Signature) `� O Waybill No.: so p <br /> ZS,CG tivilb-f►aU.Flt l% a 2 ® J G Comments: <br /> Date Time mbar of '41! ® `� <br /> Sample Identification caaa.a cava 'Mafbk <br /> AAL-a&- t 01 <br /> N r L- - 3`5 t M . 1 ucr S i <br /> 1 Ga -�; iu>-1-5z-'1c hAC' <br /> Shuttle Temperature. Turnaround Requested: F�>L L�S Sample Disposal: <br /> Standard(2-3 week) ❑ One week ❑ 2448 hour 10 Return to client 0 Disposal b !ab poaay rownuoe) <br /> Relinquished by sampler: Date Time Receiv b Rel shed Date Time Received by <br /> Reingtushed y Date Tine Received by: Relinquished ` ate Time Receivedoat la <br /> Report to: Bill to: <br /> (G� {�,Et,Jt:;n.i� �., �,�� S�rrr✓ 3``TCr :5AVY115 A5 1 'o►°r /�i��(LE . <br /> Phone*: SID `133 lits FAW. 5tG �i33 — <br /> While: Return to client with report Yellow: Laboratory Copy Pick Sampler <br /> CS 011016 c.o.c. N° 2023 <br /> City of Stockton 190855-M <br />