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www.f linc.com CHAIN OF CUSTODY ORIGIP&�L <br /> b AND ANALYSIS REQUEST DOCUMENT <br /> Client_ —ALL i E EDSEttr Sampler(s): Rush Analysis(surcharge will apply): <br /> ❑New Customer Customer Number. 3-I$723 CeL�gw 05 Day 04 Day 03 Day 02 Day 024 hour <br /> Address: 2,32 1L tQ . CI�I O-H Rush pre-approved by lab: <br /> earnCCnyy. 0. 95220 <br /> IComp Sampler Set up Date: Time:_ Electronic Data Transfer:Ayes Ono <br /> Phone: ' -GI"3- S`F2`f Falc Time: Mileage: Ifyes,To:State - Client Other <br /> E-Mail: •I .SP�f-�-G �iYl��•G'Qm Shipping Charge:_Pickup Charge: Lab number: <br /> Project name: -M?.?I? N �U tOLi <br /> Contactperson: == <br /> Billing Information(if different from above) ¢ N a = <br /> Name: <br /> Address: u ��= 3 o a of <br /> Phone: Fal „ m e > A v a p <br /> 9 m <br /> E-Mail: _ a <br /> , - ti—a <br /> t <br /> Contact person: e = +o CP <br /> ' F <br /> Purchase order/contract/FGL quote number. V S :2oa <br /> v <br /> Pre Log Required:yes_ Frequency:ManoD WeO Quaredy0 G m n s` <br /> otbeE0 z o <br /> �"F <br /> VZ`t4 <br /> 4 <br /> toil n ,t o '" N 5 = > y OA t <br /> Sample Location/Description Date Time u E o. a° „°1 6—c. � 01 X z <br /> Number Samp(XI Sampled z 1T? a. '3" m m ¢ a e. Q' <br /> / 3 I IIr <br /> CUSTODY <br /> > av)«f m m<e<m..m...am..r. <br /> e<u.am• <br /> Noz-N- >': <br /> )Job_ — 30•'- <br /> GLlfp �j RN.yW.E<C 01: Duu7 �' rime: flop Rtll.yubb<0 ) Dne: Tlm<: <br /> Q •m0 A.nL<O bT• aae: 11 Tlm.: Rcctlrrl b>:-7 D.lu <br /> Corpamto Omcee&Laboratory Ofrlw 6 Labontory Omca S,Loborutory Office 8 Luborulory Off1co&Laboratory <br /> 853 Carpora5 n Stmot 2500 SwUll etll Read 583 Eaat LM. <br /> 2m. 3442 Emprusa Drive,Suite D 0415 W.Goabon Avenuo <br /> Soma Paula.CA 03080 Stockton.CA 95215 ChicD.CA 95928 San WS Obltpo CA 93401 Visalia,CA 93291 <br /> TEL:(805)392-2000 TEL:(209)942-0 43- <br /> 182 TEL:(630)35018 TEL(805)7a3-2940 TEL:(559)731-0473 <br /> FAX:(805)525-0172 FAX(200)042-0423 FAX;(530)343-3807 FAX:(805)783.2912 FAX:(559)734-8435 <br />