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Billing Information" Analysis/Container/Pres rvative Chaino/Custody Page_of <br /> Company Name/Address. —' <br /> Fulcrum Resources Env - Monrovia, CA Don Kellar/John Winkler Pres <br /> 415 W.Chestnut Ave. Chk <br /> aceAnalytical <br /> 415 W.Chestnut Ave. Monrovia,CA 91016 <br /> Monrovia,CA 91016 <br /> Email To: _ 1 tzms L.mnan as Mahe wh:l.TN]l tl] <br /> Report to: O is�s,�m7.,.h,w. <br /> forest@frenviro.com;ian@frenvim.com Q` =� =s a.wm.��.1a <br /> Forest Kan 0m `:: ;:�,��ax,o�.�o��a. <br /> Project Description. City/State ! Please Circle: d ` l he v.anmu w=a.m rovh�malw:r.hmm <br /> Collected: Luc k-..r. C* PT M7 CT ET O. > = U -,oar <br /> zClient Project# La6 Project# Z p m 4+ sDG# 3 ��o <br /> Phone:805-338-8008 20 t D.}_ LS` FULRESMCA-FOREST a 2 E = U <br /> z <br /> Zn' 41) E v Table# <br /> Collected by(print): Site/Facility ID# P.O"# , Z .: a . V E <br /> } E <br /> �prCS 1- kwr 2u Zt C Y16S (. E E U O 2 Q Q Acctnum:FULRESMCA <br /> o o = E Template:7191696 <br /> Collected by sign Rush? (Lab MUST Be Notified) Quote It y O O to H W V O <br /> _Same Day _Flue Day d to N Z O Q G a Prelogin:P861801 <br /> _Neat Day _5 Day(Rad onlyl Date Results Needed h Q 0 0 PM:546-Tared Starkey <br /> Immediately _Two Day _10Day(Rad Only) No. W ~ t.1 V tb Q 00 PB: <br /> Packed on Ice N_ y —Three Day of U U O O d - <br /> 10 # y y y Shipped Via'. <br /> Sample ID Comp/Grab Matrix' Depth Dale Time ntrs I K p toDo ` m to R:ma=ks samoiexpm omyl <br /> _._. .— _- ------ — - - in LD 2 > -0 3 3 3 <br /> M loco ID D <br /> sot - v t,✓ V 6r' z s to Z o � '` � K - <br /> S B 2 - vk✓ is bw zs Jc3o aIFK Or J< )C <br /> S i5 3 - v vv (s S GJr -t i v 9 Fs EIT: k c <br /> GW <br /> rw <br /> GW <br /> GW <br /> •Matrix: Remarks: Saial R het is <br /> S-Soil AIR-Air F-Filter pH Temp C0c Seal Present/Intact: NP /y N <br /> COC Signed/Accurate: Y° _N <br /> GW-Groundwater B-Bioassay flow_ Other Bottles arrive intact: yz _N <br /> WW-WasteWater correct bottles used: _,if <br /> DW-Drinking Water Samples resumed via: ¢ 4 tam sufficient volume sent Le__N <br /> OT-Other Tracking 7��' O�� IE Aoelicable <br /> UPS FedEs Courier v0A Zero Readspace: _N <br /> Preservation Correct/Chocked: N <br /> Relinquis edb (Signature) Date. Time: Re by:(Sign cure) Trip Blank Receiv yes N FAD Screen <0.5 vdi/hr: y­11 _N <br /> HCL MeoB <br /> tyoc TOR <br /> Relin ed by:(Signature <br /> Dale: Time: ceived by:(Signature) Temp:�O Bottles Received: If preservation required by Login:Date/Time <br /> Relinquished by:(Sign ature) Date: Time: Receivedsfo�r�lab by:(Signature) tD�atte: J Time: �/� Hold: NCF I/io <br /> 0.7 rvCPr IL.-e m5 9-/ D�GW NCF / o <br />