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W IYVIR41`IMEnTAL CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT COPY 2 <br /> MM <br /> ! mSAMPLING REPORT INFORMATION <br /> Rush Analysis S Days 2 Days <br /> 24 <br /> h <br /> is <br /> Subject to surcharge�Ai <br /> CllenL� en -11bbl e- Sampler(s) <br /> QA/QC report required yes no <br /> Custo <br /> Addre6232 �O?e ,4(1 <br /> e- <br /> L� 1Electronic Data Transfer yes no <br /> 52,07 Comp Sampler Set up Date Time <br /> f�2) 4-77-34-71-77—3 a-7� If yes,To State_ Client Other <br /> ( <br /> Phone `Y <br /> Time Mileage Lab number <br /> FAX <br /> �p <br /> Project name Lab Loc Sp ❑ STK ❑ VI ❑ ❑ <br /> �C�.S��� 'Z7I/Io-�r5 _-_-- <br /> Contact person -::�: U0 lP m - <br /> 3 <br /> Billing Information(if different from above) - <br /> Name N 78 x a <br /> Address H N1 y <br /> v o y cam, p o <br /> Phone > ` O z C O <br /> C7 0 C": y v <br /> s <br /> FAX U a u F A rn w Q <br /> Lu <br /> On t5 <br /> Contact °0 �o ° a z a8. <br /> �l✓� �' + <br /> Purchase order/contractIML quote number o cW E. Z <br /> U u � z � � ? z o �; S+ <br /> Pre Log Re4utre& yes no d <br /> ao <br /> 5 e v a 3 3° <br /> a U a 3 C7 r y n a0 a3 <br /> I I o z ; co <br /> E `✓ r.�s. n Q ate, ?+ <br /> 4 J <br /> Sample Lot�tton/Descnptton Date Time I a 3 3 � x (� 0 ^, <br /> Num - Sampled Sampled z °: oa m h V <br /> In r' � � r 617 G 11-20 61 � 5 <br /> Z 8 <br /> a 2 /37,0 r <br /> 4 <br /> 3/ r + <br /> L 3411400 I 1 X <br /> 4 6') IJ� LLL <br /> a � <br /> REMARKS SECTION V CUSTODY SECTION V1 <br /> V Reltnq sub t dmom on the reverse of thisWvm -14u—Lf le - <br /> V r A s SOL �, }�' IJ <br /> Reltaqutshedlir Dau \\\ Tile\\\ <br /> U C U�SfG /J/— Remvad 4 lir `� �" lbte� -r1 V Tune�3 Rcmved by Date Time <br /> 11,1-1e;)577_7- /6F3 Remve b Date�Tme Relmgrusladby Date Time <br /> Revved by �—- Dgc Time Received by Dau Tune <br /> CORPORATE OFFICE&LABORATORY OFFICE&LABORATORY FIELD OFFICE <br /> PO Bos 2727853 Corporation Street 2500 Stagecomh Road Visalia,California <br /> Santa Paula,CA 93061-0272 Stockton CA 95215 Tel (209)734-9473 <br /> Tel(805)659-0910 Tel (209)942-0181 Mobile(209)737 2399 <br /> FAX (805)525 4172 FAX (209)94240423 FAX(709)714 8415 <br />