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ENVIRONMENTAL www.fgline.com CHAIN OF CUSTODY <br /> US TODYAND ANALYSIS RE( ORIGINAL <br /> Rush Analysis(surcharge will apply): <br /> Client: 1" Sampler(s) <br /> f1N`�ew Customer Customer Number: 70�4 ❑ 5 Day ❑ 4 Day d 3 Day <br /> Address: ��-G��,. .�'..�o, ce_�� �. ❑ 2 Day El 24 hour <br /> �t 3 4!C> �F't {�„ Comp Sampicr Sei up Date: Time; Rush pre-approval by Irk <br /> -..- - - I�AIt "- <br /> Phoru --��'� -�--'00 FANG�LG� `2��l Electronic DataIrsnsfer: yes —no <br /> Time! Mileage:-- <br /> E-Mail L+ C�A►A u p 1T^• If yes.To:Slat Client Othcr <br /> Project name: e� Shipping Charge: Pickup Charge; IJa6 n.r. cr: u <br /> Contact person: ^ <br /> Ruling Information(if different fmm above) Fe � <br /> Address: 01 <br /> Pbone: FAX:E Mail rLn _Contact person: �^ xPiuchaso order/corttrrletlFOLquotc number. � DO aMonthly O Wcetdy Q Quaat¢r9Y C] vI�te[ng Required: yes Freyttency: 01hcr Cl yz3 h gI . � .1 <br /> t7 O !V <br /> 5arrtple l.rtcatinnfl)eseriplirm tato Time �. � 3�� �' � I"" F- � � �' •, <br /> Nelrrtber Sampled Sampled F–' A ti_ I <br /> /U 5 P <br /> 5�/j. 10 1&nb G <br /> —4d <br /> mmin <br /> F�Hof.tn%ql <br /> .i the ti d onesondrcSQ2Q /,� C�Date /f;Jfiate(late !O� 'NlT�mcRdiequ.st+utby Date TM! <br /> Oa Iv-time_ /lYo Recas�ed by: t)atu 'rima <br /> CORPOSIATB OFFTCE&LABORATORY OFFICE&LABORATORY OFTt7CE 6 LABORATONY FIELD OFFICE <br /> B]j Cc qw�wn St-1 2500 Startecoach Wwl 563 1 GeSo ASxmte Virilia,California <br /> Sano Tula.CA vsorto Slnla1m,CA 99215 Chico,CA RW% Tcl:(396)734.%M <br /> Tel:lwk3i 3*!'_-Nrx1 Itt:1_4n1 1424M] Tel:fS.S{ii 343-..RIB Mobile:06V)737.2Yr1 <br /> VANt �-'?5-417'_ FAX:('PF)9424 4:�i FAX: FAX(SSu173•i-x135- <br />