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ENVIRONMENTAL CHAIN 014' CUSTODY <br /> ' ANDANALYSISREQUESTDOCUMENT . INAL <br /> HU <br /> Client: / 71' �'N1 Q CV !_ / (��Q /i7" Rush Analysis: 5 Days 2 Days 24 h <br /> /O /O Sampler(s): — Q� e 1 V Subject to surcharge <br /> Customer Number1. �e. <br /> .�� A TrILN'r3 �P N 2d t QA/QC report required: yes no <br /> Address: Electronic Data Transfer: yes no <br /> Comp Sampler Setup Date: Time: "3 <br /> Phone•. ��0 e/� 3(� �- 3 6 �7 r It yes,To:State_ Client _Other <br /> (2�4�� r - 7 3�O Time: n•N J Mileage:-3_ Lab number: 9.3,55-3 ') <br /> FAX: rf <br /> Lab Loc: SP ❑ STK)i VI ❑ 0 <br /> Project name: /� V- -- ( �//��f-v /� <br /> Contact person: S N er I STOP 1H K I - (7'0.S <br /> Billing Information(if different from above) <br /> �ame: u <br /> e`l.lr 3.5 Ids'Is 9 Py vLg+L Dy-, B �' C f a <br /> Address: / 1 �7 ° a s U <br /> J 1 O rCy/<�O'X. �-' 7'a 7-5.9- <br /> ry.J�t�S C7 o my 2 <br /> Phone: CO 1) '4 r0 I lv 3 3 / u Z f Q I <br /> C m 3 <br /> O L`^ ; 0 <br /> FAX: Q-6e9) 4 & 1 — to 3 4 2, v a y u g� <br /> Contact person: �1 0.C K �O f�E r 3-^ U 'u N Z <br /> -7 .$ a E �0 y a' a + u� U <br /> Purchase order/contract/FGL quote number 14'4 3 6FL� I C z W <br /> 'a( AIL 12 <br /> Pre Log Required: yes no ° O Z ? ? <br /> G v 3 o x" f ` <br /> bz <br /> SAMPLE INFORINIMION SH I ION I\ <br /> 0 8' `o c B .'o rn m <br /> Sample Location/Description Date Time <br /> Number Sampled Sampled <br /> o-Io� 1 M x <br /> it f r It sF <l h k <br /> PI II of l X <br /> IF r �l It !+ x <br /> rr ►r <br /> Ff ti, it )( X x <br /> ¢I kr <br /> IL 14 1 I I X 'C X x x <br /> 11 PM R11 R <br /> Relax; br mdiBa.a Ne rtrerrt or lhi.d9cumem: <br /> u uye i <br /> �FERd1;t.Q dj ,SHED BY: Y. STARR Ih m <br /> R vedby: D. t Oh�dr9R� REQEJUED BY: GREYHOUND D.le ,1111e <br /> iaw by: ------------ <br /> D.te If O Q lime aeram.lrta by! D.1e <br /> lk.e Wbr: A md6 .jS R«ivsl by. Date ^m /� /✓ <br /> CORPORATE OFFICE&LABORATORY OFFICE A"MILAInDRY FIELD OFFICE <br /> P.O.H.21L853 Calpm.Sneer 2500 SWec9acb Rad Y Wire Califomi. <br /> Smt.Pwle CA93061-0392 S. .CA 95315 Tel:(209)TM.%]3 <br /> Tel:(m5)659,0910 Tel:(309)942-0181 Mobik:(309)739-UW <br /> FAX:(805)525J 172 FAX:(209)%2-0423 FAX(209)n3 8435 <br />