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ENVIRONMENTAL (,MAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENTORIGINA`.: 4 <br /> F <br /> h R I I f'I A Q ],�_� �� C// CO y 1 e /r Rush Analysis: 5 Days _ 2 Days 24 hrs. <br /> to D �Rrnpler(a1 '"� 1 1 Subject to surcharge <br /> Customer Number. 6 ,/ r-&_ -I-y <br /> `YTSP h � �C� ..1- — QA/QC report required: yes no <br /> P Electronic Data Transfer: yes no <br /> < Comp SamplerSet up Date: Time:O Y\ � f � 2 � It yes,To:$tate_ Client �Olher <br /> ) (0J U, 5327,�_Q,` 7 ! C/ z � O Time: Mileage: Lab number. 11 J L_�.f� )( J 10 7 �/ y� /�e: �ht O F�,{ fSr 70 f"L I. lY a-s Lab Loc: SP ❑ STK VIon: ['C IAz N 'WL OL �mation(if different from above) �. <br /> arae: <br /> Address: f GLwV- Dr , <br /> _3-rU C & rn t G'& qs�;'o- Fi <br /> Phone: ��LOq ) 4 G 1 - 6 3.3 /y . � . z t✓ bFAX: o 63y- <br /> Contact person' J 0..C �� GO f e l l a 3^3 N `-K a+ 7 ',c <br /> Purchaseonuact/FGL quote number: U m t7 o a E f ^ $ b O L 2 <br /> Pre Log Required: yes noa zQD <br /> v z Z fty�y' <br /> c <br /> c 33 ; a y <br /> Sample Location/Description Date Time 3 3�' yy z 0 E <br /> Number Sampled SraMympled E z set <br /> f Y ..(6 IAS /� <br /> Yi If 1, II aG- t'3o 7C %e x x >e <br /> r it k X X k <br /> 11 Y r os=fi t % 50 X ?C <br /> Ir /l Uc- Y 1 3� 7rA �o <br /> �p Rclinquis dby ul object Ne ma 'man Je ie�erte of llul documeln:j� (���I{;�r�gl�Ji'l ,'Cy��Uplim"3HED BY: Y. STARR <br /> ,... .4 �l Due ""'nelll.v LIVCU Dau Tme <br /> uW f[ f R ivM bY: Dau1 S T X15^ R.iv by: _ l I Dau I_f 5-q�'Iime <br /> •.. a R li�pwshd by; Dalen 4 lime N RCli�quislN by: DeleTme <br /> R eived by: D-&5-9 k T.Mf�_ R.,i by: Due 1 Tme j.j_)LL <br /> C'E&LABORATORY OFFICE A WOKAWRY FIELDOFFICE <br /> PO,Boa 27n53 Cmpu mSO t 25110 Sugn Read Viulia•California <br /> Saran Pau14 CA 9X61-0272 S.klan,CA 95315 Tel:(209)7M-W73 <br /> UL(805)659-0910 TeL(309)W3-0191 Mobilo(M)737-21 W <br /> FAX (805)525 172 FAX:(309)%2213 FAX(M)734WS <br />