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�} �,i� Tr�^��{ CHAIN OF CUSTODY <br /> ENVIllO l'l r l;I1 AND ANALYSIS REQUEST DOCUMENT <br /> t�FtfralNAL <br /> " 4ushAnalysis: 5 Dtayesry2Days <br /> th <br /> �n2o4 <br /> ; <br /> .. <br /> .., <br /> , <br /> Client: h simpler Sbjectto sawlarge <br /> Customer Number. reportrequired yes <br /> Address:' 7v no <br /> Comp Sampler Set up DateTime: fjesoStata—Citnt <br /> Phone: _ .+ Z Time: Mitaaga: tabumher <br /> FAX Qt <br /> SPU STK Q V3 i] <br /> Project name; <br /> Contact petaoR: �/ <br /> illing InformationOf different from above} <br /> ame: <br /> gx Q <br /> Addresst y 5 d. VC <br /> c} z + d <br /> Phone: <br /> g3 <br /> FAX. p e' 3 t-41 <br /> Contact person; <br /> Purchase ordertcontrac:t/FGLquotoa mmbe; r {��' <br /> O <br /> Pre Log Required: yes - -noi u c�a 3( 4t <br /> fl <br /> w <br /> o <br /> Sample <br /> Location/Description Date Time <br /> Number <br /> S a9 Sampled � z <br /> y� <br /> 1.'ztr/ Cy l Cj r+9� <br /> E ' <br /> e. Lz/;.�- � 4J t <br /> Rdh7�uiAed by }eatotl�wau MadtAn4itioar ott the mvem orthis dowoent: <br /> heti Date r "Bine <br /> Racaired br CJ... <br /> Dew <br /> 6t 1 , ! Q 7lme f t i'`C ✓ ved by ter+ Tmc i <br /> t>tue D '15me itetitq b} : . ttwa Tina <br /> } `rC"f <br /> Gill&HOUND o.,e nma� Reeaiv ` : mm <br /> CORPORATE OFFICE k LABORATORY 0010E&rXIORATOWY Famomce <br /> P.O,Box 2721853 Cotptwatk rn strcas 2500 5tasecoach Road Yuatia•Caufomtn <br /> sant+Paula,CA 93081.4272 stoekton,CA 95215 9 {209}734-9473 <br /> Tat:{805}859.0910 T, (204}942.6181 Aio ;{209}737.2394 <br /> PAX:{805}325.4172 FA7(.{209}442-0421 fi4X X249}73 8435 <br />