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/3 <br /> ie P a ra o c Chain of Custody <br /> 13760 Mag>?alia Chino C 710 Please Priu! in pen Page of <br /> A P C L 7e1: (9Q9) 59D-16 B Fax: (909) 590-1496 1 co�o?) <br /> p Client: �� �� /�!./ Contact. �, '/ Tel # ,,5— G Fac <br /> �- Zi code: �2Addescity- _ - <br /> Billto: �` t! - _ _. - An yaia items-... -_ <br /> rQ' Project -P.O. #^ IR <br /> White-With report <br />+ _v_ <br /> Project Address , APCL Qaotal,ion Yellow-Lab copy <br /> z0il Due Date: ❑regular rush: days hours Sampled 17y: - - - �irik=brignator <br /> Field Sample Sample Date Time Scruple Preset- # of <br /> ID No. Description Collected Matrix va6lott Containers Remarks <br /> 5 Sir <br /> C7 <br />_ H <br /> ri <br /> EL <br /> lD <br /> N <br /> ,fir QC Requirement: egular; C]QA/gcRepost; ❑WIP; []RawData; ❑BxtendedRewData ❑CLP; ❑ACE ❑APUEE ❑NBRSA_(8,CorD); []Other (Pleaseepecify) - <br /> Seunple Disposal: ❑R,eturn_ZDiepotal by APCL ❑Hold for days after receiving date- It not epeciRed,samples will lee discarded 44 days after samples are received. <br /> i Sample Conditions: ❑Insect; ❑Broken. Cooler Seal: ❑intact; ❑Brolwn; ❑ None. Tag# Temperature: ❑ fiaom []Cold( OC). <br /> I <br /> Relinquished by to/Timef'a"�1✓ //,MY Received by Date/Time-2-45— <br /> d- <br /> W Relinquished by Date/Time f Received by Bate/Time f <br /> APCL USE ONLY Service # Note: <br /> Clients understand that all terms described in the proposals,quotations for this project,end/or we general terms provided in the cttrrefrt APCL price schedules will be foltowed. APCL reserves the right <br /> to terminate ita service or v,ithhoid delivery of any reports,if in APMe sole discretion the terms af the project have beep broken. <br /> Pnr.;CUaT.OATA.LA blots AIN 4.T$), <br />