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H.M _ ,� --' - .. .. ........... . .y,`�.�..'-.h�.�a. _..�..,�- - -_-..:,.ate...__. �. s.. _ .... <br /> arkus&C`d.�;2097268-45ss <br /> THE TWINING.LABORATORIES, INC. Project Name �` y�.___� �✓�f � �>r� <br /> 2527 Fresno Street, Fresno, CA 93721 Address &12 Vo W�sr <br /> (209) 268-7021 <br /> Date A5-/L~ �'/ <br /> Hchain-of- <br /> Pageof Custody and Analysis Request Record Mgr. _ai/ f �� TL# <br /> �_ �— <br /> Analysis Requested <br /> Report Ta: �� -! � Caples To: Lad <br /> �Client Name 7 Due <br /> Date <br /> Address <br /> Expected Turnaround: <br /> Contact Name N S Rush ❑ Routine <br /> Phone <br /> Contract/PO# <br /> Specify Time <br /> ^ �� <br /> S pier Name (Prin) uz� ❑ FAX# �'V' �f Q s ,��Y' .! i <br /> Client Sample Sample 13 <br /> IN Sample ID Date/Time Type i 4/Size/Type of Container Preservation/Handling: <br /> kZ <br /> . � <br /> t <br /> Each hazardous sample submitted F Water samples, please Comments: (BILL TO IF OTHER) Dept. Initials Date/Time Location <br /> for analysis will be charged a hazard- check one of the following: W;4 IT OAi FbA LEA-b C� Al 601 <br /> bus waste disposal fee. Clients that O Drinking Water 602 <br /> r*trieve hazardous samples within 30 ❑Waste Water MC i/1L5 tl i/L I tEX 7. <br /> 17/11 <br /> ddys of the analytical report date will El Ground Water(wells) 0 j 1 iJ�l �� <br /> b'e refunded any disposal fees. ❑Surface Water(rivers,lakes) <br /> 3 11ihqulshe Delivered B Received By: i Received By: <br /> S'lgnature Signature Signature - Signature r <br /> Pri ted ' '?4 L•�Y� �u, — Printed iw l / � Company Company -4,-- <br /> ,C41a6y,'• Y~�� Company G Date/Time Date/Time <br /> eil�Time.' �a—/�- /- /�/�� Date/Time !O-/t" ��" �'� �� Log In Date/Time 'Log In Date/TiMIID. / 'fy <br />