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CHAIN OF CUSTODY APPL, Inc. <br /> RECORD 4203 W. Swift Avenue, Fresno, CA 93722 <br /> Phone: (209)275-2175 <br /> 1POV Fax: (209)2754422 <br /> PlectNN me/Nu Sampler(Print) Analysis Requested/Method Number Date Shi ped: <br /> (/ , <br /> IJP Carrier. <br /> Purchase Order Number Sampler(Signature) <br /> 1 Waybill No.: <br /> L J Comments: <br /> Date Time Sample Identfcacoya Collected MatNumber d <br /> t <br /> cootalnas <br /> fA <br /> O <br /> N <br /> . N <br /> . O <br /> ' N <br /> Shuttle Temperature: Turnaround Requested: Sample Disposal: <br /> Standard(2-3 week) ❑ One week ❑ 2448 hour ❑ Return to client ❑ Disposal by Lab(3o-day retention) <br /> Relinq b m r. o l a Tim Received y: Relinquished by: Date Time Received by: <br /> ell hed by: Date Time Received by: Relinq y: Date Time Received'i t]lab by, <br /> Report to: �j/�/ % �/ Bill to. `-' <br /> Plane#:; FAX#: <br /> White: Return to client with report Yellow. laboratory Copy Pink: Sampler <br /> c.o.c. N° 1821 <br />