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CHAIN OF CUSTODY APP!_, 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 Requested/Method Number JDate Shipped: t Co 1 q <br /> A42L Carrier: Fete E?Q <br /> Purchase Order Number Sampler(Signature) , <br /> / �; , wa ltl No.: '860" q 33i-`i <br /> lI <br /> Z5C40-L2it fj••INV.FLD -71Lti,LL4 fwl-efi ` r, a�; 'r z /' Comments: <br /> V J <br /> Date Time Number of U U rl <br /> Sample Identitieation Collected Collected Mauro containers ' U <br /> NL <br /> A-Zt--11-7or <br /> "(k tP Swj -Tt3-S 4o <br /> •M fu/� <br /> a' n <br /> 0 1P <br /> V� <br /> r Ad-h401 <br /> tA <br /> O <br /> 00 <br /> W <br /> Shuttle Temperature: Turnaround Requested: Sample Disposal: <br /> 14 ( �� <br /> Standard(2-3 week) ` ❑ One week ❑ 24-48 hour ❑ Return to client Disposal b Lab `' rfer�onl <br /> Relinquished by sampler: Date Time R ed Rel( i ed <br /> ny i by: ire Received by: <br /> Relinquished by: Date Time Received by: Reli had : ate .Tiff ie, Received lab b . <br /> Jo <br /> Report to: Bill to: 77 <br /> KeE <br /> r-> <br /> rUG {�t:t/mac t.C- AoE m avo SAtviu A-f-:> A00r2 5S <br /> Phone*: SIL X13 - 2Ct CO FAX#: l3-3— 17 <br /> White: Return to client with report Yellow: Laboratory Copy Pink: Sampler <br /> c.o.c. N° 2024 <br />