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THE TWINING LABO ORIES, INC. Project Name <br /> � "` <br /> 2527 Fresno Street, Fr o, CA 93721 Address '7fO fid <br /> (209) 268-7021 <br /> Chain-0f-Custody and Analysis Request Record Mgr. a TL# 3��Y oo-I a/ <br /> Date la �� *. Copies To: <br /> Page of <br /> Analysis Requested <br /> Report To: <br /> Lab Due Date:..... . <br /> Client Name o k ill To: !�[� <br /> Address <br /> Contact Name Expected Turnaround: <br /> Phone-424!�,) X3'1- _c1 A�ROUTINE ❑RUSH VERBALS- DRUSH REPORT- <br /> Contract/PO# `Additional Fees Apply <br /> Sampler Name j Specify Date: <br /> {Prinq ❑FAX# J` <br /> Lab Client Sample Sample <br /> 1D# Sample ID Date/Time Type #/Se/TjrpQ of CarRatnei Preservation/Handling: Location <br /> eve <br /> W 1-id o/� Xbf <br /> G2t� <br /> r � ops <br /> 1 LIZ(. <br /> 4102--lo /3�0 <br /> t-J 3- <br /> 1 ff044 1041 <br /> LL <br /> AlnW3-T' <br /> Each hazardous l <br /> t <br /> W <br /> F <br /> sample submitted or Water samples, please Comments: <br /> p Dept, Infbbfs Date/Time.. .. Location <br /> for analysis will be Charged a hazard- check one of the following: <br /> ous waste disposal fee. Clients that ❑Drinking Water <br /> retrieve hazardous samples within 30 ❑Waste Water <br /> days of the analytical report date will ❑Ground Water(wells) <br /> be refunded any disposal fees. D Surface Water(rivers,lakes) <br /> Relinquished By: Delivered By: Received. <br /> By: - ReEenrec_gr <br /> Signature i Signature Signature. <br /> ; <br /> 9 Signatulrq.: <br /> printed L . Printed Company Compar►jr' <br /> Company � <br /> h <br /> =IK�adr •'S <br /> p Y � � Company Date/Time Lo. �. � ,, � � Date�rtt$ <br /> Dat6/Time -200 Date/Time Login DatefTim Log Icy ateJ ime ' <br /> SHADED AREAS FOR OFFICE USE ONLY <br />