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ENVIRONMENTAL CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT ORIGINAL. <br /> NT 1ETAILS SEC`rI0N I REPORT1 1 ' 1 • <br /> Client: F(Ei L .�� �o�e Rush Analysis(subject to surcharge): <br /> ❑New Customer Customer Number. -3'-' <br /> 2 � Sampler(a): �� 05 Day 04 Day 03 Day 02 Day 024 hour <br /> Address: 2500Electronic Data Transfer. yes no <br /> SComp Sampler Set up Date: Time: If yes,To:State_ Client _Other <br /> Phone:(2c)cr) V52-01 R I <br /> FAX: 1/./ —0` 231 Time: Mileage: _ 1R <br /> Projectname: VVCI.5r WG. er- MO/' Ac> illC Lab number: <br /> Contact person: 7 a 1 art C-- <br /> 7sz..Bil�Information(if different from above) a d <br /> Address: 3av° m ° I�Phone Uv ° zOFAX: v `� mContact person: �y a + F Purchase order/contract/FGL quote number: c we <br /> Pre Log Required: yes no � m g Z z <br /> SAMPLE1 • o = ; o � v ti w > a w °fie <br /> w 0 Cg m u, U 3 .. 'o y 0 <br /> Sample Location/Description Date Time a E 8. °' 3 3 rn A <br /> Number Sampled Sampled F z F °i �� m m d w C <br /> O I- -aa 8`00 6 N W <br /> C <br /> D <br /> a <br /> m <br /> a <br /> An <br /> IMF <br /> F <br /> ' .CUSTODY SECTION VI <br /> Relinquished by an j t to the tom) u and conditions on the reverse of this document �� �-/) <br /> �1 a— De¢'—�/�O Time /, '# Relinquished by: Dme Tinr <br /> :W by: � "-'� Date I— ]�o O Time 1v y v— ReceivM by: Date �'ime <br /> fled by: Da¢ Time Relinquished by: Date Than, <br /> RereivW by: Date Tom- by: Date Time <br /> ♦ CORPORATE OFFICE&LABORATORY OFFICE&LABORATORY FIELD OFFICE <br /> 'P.O.Box 27M53 Cm modem Street 2500 Slagecanch Road VimOa.CaOfamla <br /> Sama Paula,G 93061-072 s-11—1.a",I _.. . <br />