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�' www:fplinc.com CHAIN OF CUSTODY OWGRAL <br /> b AND ANALYSIS REQUESTDOCUMENT - <br /> Client: r6zlro I t rAn It t Q Sampler(s): t LL Rush Analysis(surcharge will apply): <br /> few Customer Customer Number: 05 Day 04 Day ❑3 Day ❑2 Day ❑24 hour <br /> Address: j ��Z- /"to Rat. KtGan [A Rush preapproved by lab: <br /> Comp Sampler Set up Date: Time:_ Electronic Data Transfer.❑yes On <br /> Phone: 2oq- S910-4?55Fax Time: Mileage: If yes,To:State <br /> Other <br /> E-Mail: rj N 2(p-7 <br /> Shipping Charge: Pickup Charge: allLab number. <br /> Project name: <br /> Contact person: 54 <br /> Billing Information(if different from above) _ 3 s m <br /> Name _ 3 o g <br /> Address: - 0 5 0 3 g xo t 2 <br /> Y <br /> m D A ` v N O <br /> -6 Q <br /> V « a] C N J Q <br /> Phone: fax <br /> OC N F <br /> E-Mail: 0 m m b ^ d N If Contact person: E G fg =c o v E a r mPurchase order/contract/FGL quote number: ii v z N m 0 S zMonthlya Weekly0 0wrtedyti C f E 3 m mPre Log Required yes_ Frequenty:othuci E sc z ,' cm s c '� ; mVmo1= O� zINN <br /> 0 Date I Time E Z <br /> Number Location/Description Sampled Sampled z '• 3 G m m a <br /> e-it It ffA le-7-2.0 0%4-2- G 3 P D W RLIOTR b ) A <br /> R <br /> F�3 _ <br /> Rtlloq byoodsublettq16 •YV <br /> Dd.: nou: NbgabbN Oy: Dae: 71me:ReehN by: Date: Time: ' Reeehtd by: Dat.. Time: <br /> Bee _ ORNIogolWed by: Dde: 'rieu: Rea+gebhed by: pate: Time: <br /> G Reehedby: Det.: Rted,W by: Dot.. Time:rOcbs&Laboratory Omce&Labors ry ce&Laboratory Omce&Laboratory Orrice&laboratory <br /> tbn Street 2500 Stagecoach 563 East Linda Avenue 3442 Empresa Drive,Suite D 9415 W.Goshen Avenue <br /> Santa Paula,CA 93060 Stockton,CA 95215 Chloe,CA 95926 San Luis Obispo,CA 93401 Visalia,CA 93291 <br /> -- <br /> 'rEL:-(209)942-0162 .___.__�ELr.(Sy0)•y43-5618 ._.__—_.-._-_ _ _._..__.TEL:(559)-794.9473___. T _ <br /> FAX:1605)b25.4172 FAX:(209)942-0423 FAX:(530)343-3807 FAX:(805)783-2912 FAX:(559)734.8435 <br />