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® CHAIN OF CUSTODY ADPL, Inc. <br /> RECORD J 4203 W.Swift Avenue,Fresno,CA 93722 <br /> Phone:(209)275.2175 <br /> Fax:(2091275-4422 <br /> Pt®;ed Name/Number Sampler(Print) Anfists Reques!a tt�lelhod Number Dale Shlppcd: �12c 2 <br /> U tiTI SAN LAIorr UV-1,4 �`;� ,;�( ti <br /> ' Canter: FEFor✓X , <br /> Purchase Order Number SagVler(Signature) -ter --- <br /> Z`iGG WWI No- 90(-7 'Z` L <br /> -C J <br /> Comments: <br /> Ll.ta Nsmterol ` <br /> Sample Identiftatlon Coaesled Cobc11ms ad MW11 ow"iaen t1 U) <br /> 0 <br /> 3 <br /> Shuttle Tomperalure; 7umaround Requested: Sample Disposal: <br /> .� 1A Standard(2.9 vre ❑ One week ❑ 244a hour 113 Return to cment 10 Disposal by Lab Isamy..+.ftbo„l <br /> I Relinquished by sampler. Date I Tune Recetyed by: Rel' shed Dy <br /> \"1 Relinquish/ed/by. Dale nme Received by. Rehm wish by to Tim Rgceived b <br /> y. <br /> rn<t Report to: ail to: <br /> G�VIA <br /> CIO PnoneM - X133- )CSL FAX#: �'(. S— 1 3 <br /> rn Whke: Return to client v h report Yah00%. Laboratory Copy Pink Sampler <br /> C.O.C. N2 3120 <br /> CS 011038 <br /> city of Stockton 190855-M <br />