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- .• ... - .. . . H.Markus&C0.--2091266.4555 <br /> THE TWINING LABORATORIES, INC. Project Name f'/r �A .STeKi(To.J Saft/�c� Cts <br /> 2527 Fresno Street, Fresno, CA 93721 Address y0 110 W17— LAoie <br /> Date 10— <br /> (209) 268-7021 �77-01JCA, <br /> /l. � 9f <br /> Pageof Mchain-of-Custody and Analysis Request Record Mgr. _ o—hW UAL-TT TL# <br /> _� �_ <br /> Analysis Requested <br /> Report To: r� Copies To: <br /> Client Name ' Lab <br /> Due <br /> Address Ae) S e-ecT Date <br /> EZ4fNe GA, Expected Turnaround: , r <br /> Contact Name 12/.-e-- _SAI VAL 0 i 91 <br /> ❑ Routine <br /> A Rush <br /> Phone <br /> Contract/PO# Specify Time <br /> m <br /> ^ pler Name o I 1 ' <br /> (Print) 17 FAX# ` ;� J <br /> Lab Client-- Sample Sample tt/Size/T e of Container <br /> Dff Sample ID Date/Time Type YP Preservation/Handling: <br /> SLecv K X / /ti yb F <br /> "ell <br /> r <br /> 5-Z —..3 eft r7rE S tj r4 ,. - <br /> 3`7-7 j wesT OlsYlt rL <br /> 1,6A-r'01 _f-AS7 V,i �Alb7 <br /> 55 <br /> ll, i For Water samples, lease Comments: BILL TO IF OTHER Dept, Initials Date/Time Location <br /> Each hazardous sample 'submitted P p ( ) p <br /> for analysis will be charged a hazard- check one of the following: 4rro"S 601 <br /> ous waste disposal fee. Clients that ❑ Drinking Water �t 602 <br /> retrieve hazardous samples within 30 ❑Waste Water 1�E i qLC' L(ati1 t LL I�TEX J7 I f <br /> days of the analytical report date will ❑Ground Water(wells} , I603 `T <br /> be refunded any disposal fees. F1 Surface Water(rivers,lakes) TPL rj / E 1sF�[,y 604 / <br /> Reiinquishe y: ,Delivered B Q' Received By: 6L rl Received By: <br /> Signature Signature r Signature Signature <br /> Printed /��iy.y� �l�Y� M� Printed A Company Company <br /> ]N k <br /> Coni any 4 Company G, Date/Time Date/Time ^-116 <br /> Date/Time fG� /�' ���.4� Date/Time 6— 6' L— �� R'SPM Lag In bate/Time Log In Date/Time <br />