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x' =' W _THE T IN B <br /> OR , INP - ProjeRamT <br /> 2527 Fresno Street, T, CA 93721 Address E - <br /> (209) 268-7021 <br /> achain-of-Custody and Analysis Request Record Mgr. keL11.0 (IL-L,t' , TL# '.' `) "'��L� <br /> Date_ �i r 4?`7 <br /> Copies To: <br /> Page __`of / <br /> Analysis Requested <br /> Report To: + ;, 'QQe p Tg a= <br /> Client Name <br /> E+ ' nC 1C �x Bill To: :fir-` : 4; t~ . gjj <br /> AddressCA <br /> Contact Name i c-t. -�rfc, k���'riExpected Turnaround: <br /> Phone ROUTINE 0 RUSH VERSALS* ❑RUSH REPORT* 2 <br /> Contract/PO# <br /> "Additional Fees Apply <br /> Sampler Name Specify Date: <br /> (Print) ❑FAX# r <br /> } Client Sample Sample ? /� �` p <br /> ht(S$ Sample ID Date/Time Type .-f/Size/Type of eptltalrler', t?r9ser`vatlOn/HandltngL =' Loea iArt <br /> )I.a,,,_,.1 - f (��`'=`'F'`1 ;35�5 l,�ici �°�r �'.�� �[3AS ) ,C� �3F`12 �. � � � ,�. � ,.� V(Li! �w. ,V'171•Fir�} <br /> U �C� {f a� r >r..-r_-.rfi�r=cc-1, k"' r''�•IJ <br /> <� <br /> ? <br /> x��ai`-7 <br /> -7� <br /> Each hazardous sample submitted For Water samples, please Comments: BR ttlajS ��»atelT me i c ation " oy*'; <br /> for analysis will becharged a hazard ch ck one of the following: <br /> ous waste disposal fee. Clients that p Drinking Water <br /> f �1- Yal7G Y. ^h 'e;, Plh:s e' .rs LY 9rF.4c1n <br /> retrieve hazardous samples within 30 ❑Waste Water .st._al? �r,,,��' s�7 r. �,,� ����y/ . , ��+.� �,,„,�i� � FR ��rl. ��✓,f�5 <br /> days of the analytical report date will ❑Ground Water(wells) r- <br /> be refunded any disposal fees. El Surface Water(rivers.lakes) <br /> Relinquished �` yam( Delivered B ' 1 ` ' Psy' Y a 1eCeiY6 $ijj�K At <br /> .Signature %r `' Signature J '�. it& r , .. �, FSip <br /> '_ =� <br /> Printed Printed �� t�ln fit? _M-15 <br /> _ <br /> Company 7L Com.party <br /> Date/Time -Z8(2-r Date/Time 6,Z22ZV /R%rti <br /> SHADED AREAS FQk OFFICE USE ONLY <br />