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f r <br /> 1 HE 4WININL i_AB�f'iAro4llc3, irk. L ProjL� amef ��c' <br /> 2527 Fresno Street, Fresno, CA 93721 Addresst,nr <br /> r (209) 268-7021 <br /> Chain-of-Custody and Analysis Request Record Mgr. V TL# <br /> Date // Copies To: <br /> Page-t--of Analysis Requested <br /> Report To: `- Lair Dui£1Nt <br /> Cliff t Name <br /> Bill To: r' <br /> A�d re s � � <br /> J> ��1cvt� Expe ted Turnaround: <br /> prStact Name b <br /> Phone al OUTINE ❑RUSH VERBALS' BRUSH REPORT' <br /> *Additional Fees Amply <br /> Contract/PO# <br /> Specify Date: <br /> Sampler Name (Print) ❑FAX# �? i <br /> Client Sample Sample <br /> #/Size/Type of Container 4 Pr9servat4arr l r g:it CaQ <br /> Sample ID Date/Time Type ,. <br /> n a� <br /> 2 <br /> c ,w <br /> SetJ / J a. <br /> Each hazardous sample. submitted Water Sample Key: Comments: Dept ')Dlttals ; CfeJl'tme a t <br /> a hazard- ❑Drinking Water. <br /> for analysis will be charged <br /> ous waste disposal fee. Clients that El Waste Water <br /> retrieve hazardous samples within 30 ❑Ground Water(wells) <br /> '-days of the analytical report date will Cl Surface Water(rivers,lakes) <br /> be refunded any disposal fees. <br /> ❑Storm Water -REWUQUSU <br /> REUNQUI94-0 BY: DATE/TIME ED BY: rr•5; <br /> t <br /> PRINTED NAME: ` n� COMPANNY•� � 1 ,6n PRINTED NAME: 'Co.MPANY: <br /> RELINQUISFt�p BY: DATE/TIME REUNQUISHEO BY: 4, <br /> PRINTED NAME: COMPANY: PRINTED'NAME: COMPAW J,'; <br /> t�^rJN�UISHED BY: DATE/TIME. RELINQUISHED BY <br /> 'NAME: COMPANY: PRINTED NAME. COMPANY <br /> --- <br />