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PRM300 H WRO-M CHM OF CUSTODY IgIppi <br /> Analytical Laboratory <br /> 3935 N.Coronado Ave,Stockton CA,95204 Phone:(209)477-6105 Page Of <br /> 1 1 <br /> Work Order No. 2011104 <br /> Ck�ent Name ro ect Name <br /> Requested egwrement Hequested Turn Around <br /> UniFirst Corporation Effluent(1 per Week&2 per Wec Excel EDD ❑ <br /> Client Contact Project Number Geotracker ❑ Rush requests subject to <br /> William GearyUFC additional charge. <br /> DWO upload ❑ <br /> Address Project Description <br /> 819 N.Hunter Street o QA/QC Rush requests subject to lab <br /> Regulator ❑ approval. <br /> City PO Number N State Specify: <br /> ❑ <br /> P <br /> Stockton <br /> v) <br /> State/Zip Shipp d By N Specify: Standard(days) <br /> CA,95205 17 <br /> Phone fax Matrix Global ID Expedited(days) <br /> (209)941-8364/(209)941-4022 sediment❑ other❑ N <br /> Sampler Sampler na re Potable❑ Soil❑ V) S <br /> Q ystem ID Due Date <br /> Waste W Surface❑ O <br /> ca <br /> reservation•.v e <br /> Sample Type Matrix Container Laboratory Work Order No./ <br /> Laboratory Work Order No./ID Sarqw Date Sampled Time Code Code Count a::1 Sample Condition Temperature Sample ID <br /> Automatic 24 hrs Composite Sampler 1l �i i�� I C W 1 1 <.. b 7 <br /> Y <br /> Relinquished By DateIme R:;6/ Jt ate/rime SAMPLING <br /> 1 f Q Special Instruction <br /> Date/nme Receiv y Datefrime COMPOSITE SAMPLER SETUP: <br /> Relinquished By Sampler(s) <br /> Relinquished By Date/Time Received By Date/rime Date Setup w r• 7-7--m- UV <br /> Cooler Numbers and Temperatures comment <br /> Matrix codes: W=waste Water Present.Codes: 1=Store cool at 4°C <br /> cont.Codes a=1L Poly-Unpres <br /> Page 16 of 21 <br />