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Frontier Analytical Laboratory FAL USE ONLY <br />5172 Hillsdale Circle <br />El. Dorado Ilills, CA 95762 Laboratory Project No. <br />Tel: 916-934-0900 Temperature: oC <br />Fax:916-934-0999 <br />Chain of Custody <br />www,frontieranalytical.com <br />Please Print in Pen Page i of <br />CLIENT INFORNIATION- <br />INVOICE INFORMATION (if differentfrom clieiLEfL <br />PROJECT INFORMATION <br />Company Name: Brusca Associates, Inc. <br />Company Name: Same <br />FAL Quote 4: 3310 <br />Contact Name: Joe Brusca <br />Contact Name: � <br />P.O. #: <br />_ . _.._.__ . <br />Address: PO Box, 332 Roseville, CA 95661 <br />Address: _-- <br />Project #: —1- — ODZ <br />Phone: �1 F -.C,.7.7 147�p irax: _-- — <br />P11opc: fax: <br />Project Name: �Pl lZv> <br />TA'r (business 15 10 5* 3*. (done <br />Email: ibrusca@bruscaassoeiates.com <br />Email: <br />stays): <br />FAL must agree with )rice and RUSH TAT in ivritin , <br />REPORT INFORMA'T'ION <br />REPORT DISTRIBUTION (email onlX is preferred) ADDITIONAL INSTRUCTIONS <br />Report Level; I/II 0 111 IV <br />01-Iardeopy <br />J70e J0 h �n —TA -T - <br />[—]FDD: E] FAL Basic 0 Geotracker <br />QCD (.pdf including F DDs if requested) <br />LA � 1"Z) l �S <br />®ot�,er: ___[] Custom: C'o„tact FAL <br />❑Ema'il (.Pdf including -EDDs if requested) <br />OCalifomia State Drinking Fater Form <br />System #: Source fl; <br />**CONGENERS **TEQ <br />Sampler: Employer: <br />t= <br />n ! � ° 2,3,7,8-TCDD oily 1998 WHO <br />i M O O O ?P Oy <br />o N ocyv d O er 02,3,7,8-TC'DU!F only 2005 WHO <br />Sam )Ie Ill Date <br />00 00 <br />Time t�`IatriA Q ¢ a ¢ Pi .vii l' (Cla Glx) Other <br />0. <br />C llected p w ` "" w w o Remarks <br />to -.5t .So LZo <br />z SP.3 Z <br />10: 57 <br />3 SP3 -.3 <br />WOO �C <br />4 SP -3- <br />(:®z ._ <br />5 SP3- <br />6 3 6 <br />J (.,® <br />7 <br />8 3_ <br />9 <br />lo <br />L <br />�_2 <br />12 <br />13 <br />14 <br />15 <br />Samples will be dis,osed of 90 clays after sample recent wtJes5 otlrei aria) cnients liace been wde wid aereed a ion in ,vritiug. <br />R in 'shed b l: (Si Tnature and Printed Name) <br />ate Time Received bv: (Si filature and Printed Name) <br />Date <br />Thne <br />Client uixlersttuieis that all teru,s described u, the proposals, quotations, anufor tile -general terms'provtaeu to tile cturent r1kL price sc1teauies)D00t1tR, 0 U(M022 <br />FAL reserves tie eights to terminate its service or withhold delive,y of reports, if in F.AL's sole &creiion the terms of the protect have been broken. <br />0 <br />0 <br />1-6 <br />14, <br />