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M M M = M M <br /> %PW1`IVIRONMENTAL CHAIN OF CUSTODY <br /> `r AND ANALYSIS REQUEST DOCUMENT 'OP '2 <br /> 01 SAMPLING SECTIONF <br /> yy� �i _ ��>�P✓ Rush Analysts 5 Days 2 Days 24 hrs <br /> Client <br /> S d le Sampler(s) Subject to surcharge <br /> /� <br /> Customer Number QA/QC report required yes no <br /> Address �Z Z �! mP7�/� <br /> Electronic Data Transfer yes no <br /> Comp Sampler Setup Date Time <br /> If yes,To State_ Client _ Other <br /> Phone �oyJ �7 -3-1-71 Time Mileage Lab number <br /> FAX .�/ /� r, Lab Loc SP STK VI <br /> Project name /1//D 7 �S ❑ ❑ ❑ ❑ <br /> Contact person err11,14oP <br /> Billing Information(if different from above) U <br /> r Z3 <br /> Name o. Q x <br /> Address <br /> t7 S O L1. 0 O ►�'' <br /> .� 3 <br /> z t` O <br /> Phone 0 'r- o' b y H <br /> H r, <br /> N o > C o �: ti N r r a tij <br /> FAX �' <br /> h. <br /> tact person C y 0. + �W Ja ^ <br /> Purchase order/contracUML quote number U u o ro H a 0 ; <br /> Pre Log Required. yes no a v z s ;!, Z z O' t z 7 <br /> c � 3 3 � i7 :•; a N y x � � $ <br /> #y ° J <br /> sample Locatton/Descnptton Date Time $ 3 .3,SAMPLE INFORNIATION SECTION IV 0 <br /> Number Sampled Sampled E z t c?3 0�0 w `' U <br /> 1015 G I MW S C <br /> ra + LAE <br /> ` 3A4 tO- - Z 1034 1 <br /> E 1141 -4 -S12 1040 <br /> r5 M - — I a5o <br /> (,(1 - 1100 I ) <br /> '1 /I4 W - /110 �C <br /> REMARKS SECTION \1 1-61 <br /> Rehtp wb c o the t odtntttw oa the revere of thn nt `� _ <br /> ZZ7� f rn Time y 31 Relsmphedb)r Daoc Time <br /> i Kh 1 6 Ractved ctl�� Date nttte Rearivad by � Time <br /> Z �' Re(i by- <br /> . <br /> y Reltngwsbedby Dale Titin <br /> Received by Dare Time Reoraved by - Date Time <br /> CORPORATE OFFICE&LABORATORY OFFICE&t ABORATORY FIELD OFFICE <br /> AO Box 272/853= Stmt 2500 Stagecoach Road Ysall�Calkfor is <br /> Sarna 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)94210423 FAX(709)714 8415 <br />