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me" MM M M M M % M � M M M M aV <br /> qP lied P & Ch Laboratuy Chain of Custody <br /> A P C L 13760 Magnolia Ave Chino CA 91710 Please Print to pen Page _�,,,,of <br /> Tel (909) 590-1828 Fax (909) 590-1498 <br /> Client S6 4oz Contact Tel# Fax# <br /> Address Za City a Zip code <br /> Bill to ', nalysts Items <br /> Project Name/Code Job# PO # ° �° White-With report <br /> Project Address 5 APCL Quotation # Yellow—Lab copy <br /> Due Date []regular ❑rush days hours Sampled b , Pink—Originator <br /> Field Sample Sample Date Time Sample Preser- # of 5 <br /> ID No Description Collected Matrix vation Containers Remarks <br /> if <br /> M <br /> 3'x.5 /Sa <br /> D�- <br /> �- - 30S &3r) <br /> r- � <br /> �1 - - Y <br /> p- 9 - 031 <br /> 6P - 9-'7 %-)- 1aL/ <br /> MIS 7e_ <br /> QC Requirement MRegular, ❑QA/QC Report, ❑WIP, ❑Rnw Data, ❑Extended Raw Date []CLP, []ACE ❑AFC£$ ❑NEESA_(£,C or D), ❑Other (Please sp—fy) <br /> Sample Disposal []Return fRlhsposal by APCL []Hold for days alter receiving date If not specified,samples will be discarded 45 days after samples are received <br /> Sample CondttIons ❑Intact, []Broken Cooler Seal []Intact, ❑Broken, ❑ None Tag# Temperature ❑Room ❑Cold( °C) <br /> Relinquished Date/Time 3/31o� / 1315 Received by V Date/Time 3/31106 / <br /> Relinquished by Date/Time / Received by Date/Tune j 31.)64 / Wl0 <br /> w PCI. USE ONLY Service # Note <br /> Clients understand that all terms descnbed in the proposals,quotations for this proJectand/or the general terms provided in the current APCL price schedules will be followed APCL reserves the right <br /> to terminate its service or+nthbold delivery of any reports,if in APCL's sok discretion the terns of the project have been broken <br /> AwwL FC TMS TINA t&RIC-MAM_Rfl[]T TRY wn,kris nATA i aA1G})AiN4 TBX <br />