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L Pro�. 3me f- <br /> 2527 <br /> t rIE �wii`IIN�,, �aBdri;=,tOt�i��, If�.. i `� yc,�i^ � . <br /> 2527 Fresno Street, Fresno, CA 93721 Address <br /> (209) 268-7021 <br /> 'Chain-of-Custody and Analysis Request Record .Mgr. tt .Sw�O TL# O ��-� • <br /> /a / � D <br /> Date Copies To;,rL_ -}~ . ... <br /> Page of Analysis Requested _ <br /> f - Lab title batk`e°� ¢ <br /> TO,-. <br /> Re ort <br /> Report k � Bill To: >^ S <br /> Client Name <br /> l Det-v�o <br /> Addr ss y�'� n ' f r« r <br /> Te, <br /> Contact Name �1.�h*� - Exp d Turnaround: t Ys s ., <br /> Phone OUTINE ❑RUSH VERBALS' ❑RUSH REPORT' l ,;, — S <br /> 'Additional Fees A ly 'J r <br /> Contract/PO# <br /> Specify Date: <br /> P Y <br /> Sampler Name <br /> (Print) ❑FAX# P � <br /> Client Sample Sample Ir/SipiTypeQfContainer (�- }° �'rese et;o� asl iA r <br /> SampleID Da e/Tim .Type <br /> ti <br /> )61/-7 —501 1, tJc3� <br /> 2 ` <br /> _ 2 acs 4t .� <br /> R I 5 <br /> 62 <br /> a <br /> E2 - Y : <br /> .. i <br /> ti <br /> w. 2 ys 15-n <br /> r5. <br /> Ve <br /> ��r F W <br /> :Z If ya- i <br /> 3 – j h X22 16` r <br /> r s <br /> Gf <br /> _ De Initials 'O'D <br /> Comments: T,t e r L et ort <br /> Each hazardous sample submitted Water Sample Key: <br /> 601 ti <br /> for analysis will be charged a hazard- ❑Drinking Water <br /> bus waste disposal fee. Clients that ❑Waste Water 602 <br /> retrieve hazardous samples within 30 ❑around Water(wells) <br /> days of the analytical report date will Q Surface Water(rivers,lakes) <br /> be.,refunded any disposal fees. ❑Stonn Water 604ED r� <br /> FtEdNQUISfiEO B1V 1 1 f COMPANY: �*.�..--� DATE!TIME ��/a S �� Q RINTED NAME BY COMPANY: T <br /> PRINTED NAME: K lJ <br /> RELINQUISHED BY: <br /> fIELINQUISHFD BY: DATE ITIME e X i <br /> PRINTED NAME: COMPANY:. <br /> PRINTED NAGE:' COMPANY: r' <br /> RELINQUISHED BY: RELINQUISHED BY r= <br /> DATE/DIME' ?RWTEDNAMI: <br /> PRINTED NAME: COMPANY: <br /> � _ .•„ter <br />