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CLS - L( S CHAIN OF CUSTODY CLS ID No.; fiodkOb LOG NO. 2+J137 <br /> REPORT TO: CLIENT JOB NUMBER ANALYSIS REQUESTED FIELD CONDITIONS: <br /> NAME AND ADDRE S ` A oZ.o 0 7 <br /> T N <br /> DESTINATION LABORATORY <br /> �i r D cL S G 14 bZCLS (916) 638-7301 M IN <br /> PROJECT MANAGER PHONE# 3249 FITZGERALD RD. m q o q COMPOSITE: <br /> -r F- C� 44 RANCHO CORDOVA.9CA, cn5742 m � X <br /> PROJECT NAME m d <br /> SAMPLED BY ❑ OTHER d Q u �kA <br /> JOB DESCRIPTION m � <br /> W TURN AROUND TIME SPECIAL INSTRUCTIONS <br /> SITE LOCATION / <br /> SAMPLE CONTAINER 1 J o a o o o <br /> DATE TIME IDENTIFICATION MATRIX NO. TYPE <br /> Ow ,3 vo& I�3 X Mor <br /> w _2 voa �C K S� f3 <br /> w - 0 g <br /> eln w -61 <br /> MV✓ -I Z <br /> rnw „ 3 <br /> - tib <br /> INVOICE TO: <br /> M W <br /> vJ " lo <br /> E w -2 <br /> P.O.# <br /> t - QUOTE# <br /> SUSPECTED CONSTITUENTS W SAMPLE RETENTION TIME PRESERVATIVES: (1)HCLCOLD <br /> (2)HNO3 <br /> E NQUIS D Y(SIGN) PRINT NAME/COMPANY DATE/TIME RECEIVE BY(SIGN) PRINT NAME/COMPANY <br /> RECD AT LAB BY: DATE/TIME: ( CONDITIONS/COMMENTS: <br /> SHIPPED BY: FED X ❑ UPS ,OTHER AIR BILL# <br />