Laserfiche WebLink
rr. r ffltA4M1y1%aMab%Ta ie5� lnr. LMePJW P"L <br /> y Regulatory ❑ Yes ❑ No CC: ❑YeAw No <br /> 1405 Kansas Avenue, Suite."A" Phone: (209) 572-0904 <br /> Modesto, CA 95351 Pax: (209) 572-0916 Regulator: rJ �iLGfN � <br /> Phone: (2vq) <br /> Client: -T711t-r_ CHAIN OF CUSTODY Fax: ( ) �� - 2-�2�- <br /> Address: Z Original To: JASOVt Dig, <br /> City zip Reporting: EDF ❑ EDT <br /> Project ID 5[Z)JCk0VX CJ9fj (—Z& Lah Use Only <br /> 1 / I_....... ._...._..... <br /> (Print Name) ti <br /> Sampled By <br /> (Signature) U V 0 <br /> Container <br /> Date Time Sample type Sample ID z �'V !. Lab YD# <br /> Crab Comp Matrix Type Size p. <br /> V(A`I X RemarkslF 3criZCU <br /> f OZ_ - Zo 1 <br /> ! I o9 � <br /> tEktm K, �3a�Zb <br /> i <br /> Remarks <br /> Relinquished by(Signature) DateTime Receiv d b ( igna )� Date Time <br /> ro_/O. fz.as- <br /> Relinquished by(Signature) Date Time Re eive by(Signature) Date Time <br /> Preservative Matrix <br /> Q-4°C Q-HCL ©-NaOH Q-Na2S203 0-HNO3 Q-H2 SO4 Q-Other 119Drinking Water SWaste Water 4WHazardous Waste (Water) @Soil/Solid <br /> Site Time: - Driving Time: Time Mileage <br /> Start: Finish: Total Hours: Start: Site Arrival: x2=Total: HO <br /> Turnaround lime ❑Standard ❑Silver Rush ❑Gold Rush ❑Platinum Rush ❑other: Approved By: XM1b3 <br />