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CHAIN OF CUSTODY RECORD <br /> APPL, Inc. Phone: (559) 275 2175 <br /> 4203 W. Swift <br /> Fresno, CA 93722 Fax: (559) 275-4422 N° 8 5 0 4 <br /> C.O.C. <br /> Report to: PLEASE PRINT / A Invoice to: PLEASE PRINT <br /> Company Name '� / ' / - (� Phone: Zd4' ZS3� Company Name Phone: <br /> Address ;d/A1 J- v✓T <br /> __ // _ —7j�j/ Address <br /> IC��'V� C,L( Fax: /`T y <br /> //-- Fax: <br /> Attrr Attn: <br /> of t Name/NumberSam er(Print - Analysis RequestedlMethod Number Date Shipped: <br /> -7"a _^ / J�� !t f� Carder. <br /> Purchase Order Number Sampler re W Lel v ` Waybill No.: <br /> ` V y <br /> Comments: <br /> Sample Identification Locaeon Dale Torre Maldx Number of N. `C' ` �lM�v1 <br /> Coll. ed Collected Containers \ 4 <br /> <br /> <br /> <br /> <br /> <br /> RECEIVEDShuttle,Te perature: Turnaround Requested: MUST CHECK ONE Sample Disposal: OCT [dUl <br /> E] tandard(2-3 week) One week ❑ 24-48 hour ❑ Return to client Disposal by Lab rla d.r.an ) <br /> in ed y s mpler: to Time Received by: Raftnquished by: Date Time Received by: <br /> Re inquls ed by: Dat Time Received by: Relinquished by: Date Time Received at lab by: <br /> White:Return to client with report Yellow:Laboratory Copy Pink:Sampler <br />