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° �- - � �� { 71 -,; r e 1--1 Ei IR nE `TS CHAIN <br /> OF CUSTODY <br /> -"� I 'Tirol AND ANALYSIS REQDEST DOCUMENT <br /> ORIGINAL. <br /> Client; Al <br /> r S n _Assoc MUM <br /> ❑New Customercustomer Number: Sampler(s): .!r Owl Ltush Analysis(subject to surcharge): <br /> Address: ❑5 Day 134 Day U3 Day ❑2 Day ❑24 hour <br /> Electronic Data Transfer: yes no <br /> Phone: Comp Sampler Set up Daie; 71me. '[yes-To:State <br /> y Client Other <br /> FAX: Time: �...—`_ <br /> Mileage: <br /> Project name: Yaw U1 eN q (fir' Wl/�cr �j <br /> Contact person: We�G / Lab number. v! O <br /> Billing"'formation(if different from above) f O <br /> Name: -t <br /> Address: <br /> X 3 a M �! <br /> L � <br /> Phone: a b O <br /> FAX L�7 ` w 3 as Z O <br /> � u :� �. O vi � f•- 1 <br /> COnlact person: <br /> Purchase order/eontracVFGL quote number: y Cr° 4.) <br /> r �y C <br /> Pre Log Required: yes no t2 67 Fes^. O ui V <br /> m bu <br /> tz C7 ° ° a O <br /> ' U 3 3 0 z a o IJ Z <br /> o u05 <br /> s T a G <br /> Sample Location/Destription t3 <br /> Number Date A°. 3 ° <br /> 1 Sampled Sampled F' x y 3 q J x C <br /> cn <br /> a <br /> d <br /> cL <br /> as <br /> 0 <br />� N � <br /> Rdtnquishe 6 ands bjeet to <br /> F <br /> and di600 earihiadocument: <br /> Da1c��Tima <br /> M Receivned�b. _ H— <br /> ��'�q[� �� RelinquichW by,. <br />" ILIN Datell:f--! ! 2,� <br /> ` �e�7-�7�g��yug Y; Y. STARK �� �T Received 6y: rTa– --Time <br />� �CC;Ct Date 3-9 nate prime <br /> Received by: l D Time Relinquished by: <br />.–i COAAORAT6 OFFICE&LABORATORY Dale Time Date 71n�e <br /> P.O.Box 2721953 Caeporation sheet ~'� — Received by: <br /> Santa Paula,CA 930(1.0271OFFICE&LABORATORDale Titne <br /> Td:(8051659-6910 Y <br /> 2500 Ssageaoacb{toad <br />