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S� M M m o i M M M M m4r M <br /> Apples P &lC1h Laboratory_ Chain of Custody <br /> A P C L 13760 Magnoha-Avc, -Chino CA 91710 Please Print in en Page �of <br /> Tal (909) 590-1828 Fax (909 590-1498_ P -g_ . <br /> Client Contact Tel# f14 g Fax# /4, _y2-4_-ie' <br /> Address City State 61Zipcode <br /> Bill to S IZA-v✓ Analysis Items <br /> Project Name/Code Job# P O # White-With report <br /> Project Address ,>1s APCL Quotation # Yellow-Lab copy <br /> Due Date regular ❑rush —days hours Sampled by fa u W N,�� Pink-Originator <br /> Field Sample Sample Date Time Sample Preser- #of Z <br /> ID No Description Collected Matrix vation Containers Remarks <br /> R- 3 <br /> M vii-2 2 12 57� <br /> W CI <br /> L!_ 3,5- 31#w'i a. <br /> - 5 -S'9 3� a E7 7►5 /V 4 s hwW saA3H' <br /> P_ IF- 3/3a c 1205 ! Sit Ne o? -2 <br /> ti.?-7 - 54Y.5- fay 6 1 30 f <br /> 13P-9 - 5& <br /> 1 xxM I <br /> (Oct5 &i <br /> /l±7 0 r <br /> XK I _ r <br /> 0 it <br /> QC Requirement MR,egular, ❑QA/QC Report, ❑WIP, ❑Raw Data, []Extended Raw Data ❑CLP, []ACE ❑AME£ ❑NEESA_(E,C or D), []Other (Please specify) <br /> Sample Disposal ❑Return Wisposal by APCL ❑Hold for days after receiving date If not specaSed,samples wail be discarded 45 days after samples are received <br /> Sample Conditions ❑Intact, ❑Broken Cooler Seal ❑Intact, ❑Broken, ❑ None Tag# Temperature ❑ R.. ❑Cold(_°C) <br /> Relinquished b Date/Tilde 3/3VIer,, f 1315 Received by 11 da4M7V?, Date/Time !3/31/ft <br /> Relinquished by Date/Tune / Received by Date/Time <br /> APCL USE ONLY Service # Note <br /> Chents understand that all terms described in the proposals,quotations for this project,and/or the general terms provided in the current APCL price schedules will be followed APCL reserves the right <br /> to terminate its service or withhold delivery of any reports,if in APCL's sole discretion the terms of the project have been broken <br /> R„n1-Iiiw IClIST DATA LABICHA[N_RODT TEX Fne ICUST DATA LASSCHAING TEX <br />