Laserfiche WebLink
CHAIN OF CUSTODY RECORD AND ANALYSIS REQUEST <br /> v <br /> N 551D0 t3oscefl Common Fremont, CA 94538 Tel. 510 490-8571 Fax (510)49D-8572 <br /> -r 0AM51TE Project Manager: TELL. L Bill to: <br /> w E N V I R O N MENTAL Client Name= R &C Company_ <br /> LABORATORIES, INC. Address: r �� <br /> f� Address: <br /> City, State ZIP City, State ZIP <br /> Phone: Phone: <br /> Date: 01 Ias-[g? Fax: r, Fax: <br /> Page: a- of <br /> Laboratory: pj., �-Je Project Name: P_O. No.: <br /> Lab Number: Project Number: <br /> • Analysis Reippsted <br /> LnLn <br /> O <br /> m <br /> U m 6 � o M LD is <br /> O a W m <br /> L7 Q 6 a 'a) ❑ X , �p�ll <br /> Sample Identrfiration Date Sampled Time Sampled hAatrix f° 5 E � 0 � a a �} 0 <br /> w _j m �- Z Remarks <br /> Q `pts-,St :1 fes g 1o, q& V r- V4u _ 0:Les M'i lg03i-29 �C <br /> t?: S ti <br /> ti {5—Zai to Fl K 7:21 <br /> Pi4 �2o( K� <br /> ( r� `i it (V!9 <br /> rN -3S <br /> yr vt 4`07 �t 1h [ilps _ <br /> 1tS` o r r L Q L 1 r l •• <br /> LD <br /> 39 <br /> Lo <br /> Initials: Printed flame: Signature: Date: Total Containers- <br /> C'4 <br /> ontainers:m 1{1 A ci ae l _qC"_r0Vg,--4 Start Time: Received Intact- <br /> o � �� Stop Time: Received Cold: <br /> " Hours: Custody Seals: <br /> Client Sign-off: <br /> White Copy -Admin/Lab Yellov,,-Mobile Lab Pink-Client <br />