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ENVIRONMENTAL AND OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT COPY 2 <br /> CIAENT DETAILS SI---CTt0NI SAMPLING st.,CTION, It REPORT INFORMATION si---CTION III <br /> �I <br /> l r� <br /> Client: �t� ����t 1 1 1/ 9L—C4 � � Sampler(s): �/ j J(]j Rush Analysis: 5 Days u Days 24 . <br /> — Subject to surcharge. <br /> Number: QA/QC report required: yes no J <br /> Address: <br /> Electronic Data Transfer: yes no III <br /> r Comp Sampler Set up Date: Time: If yes,To:State— Client Other <br /> Phone: �U �-� ��C� � k' <br /> Time: Mileage: Lab number <br /> FAX: <br /> L.�!�u r �n 1 (�.-a Lab Loc: SP a STK ❑ VI ❑ ❑ <br /> Project name: ( I V 1 H <br /> _ <br /> -Contact person `✓� �'Ct �_ _ - -- <br /> \ I(� tiling Information(if different from above) <br /> Name: R o x <br /> F R v <br /> Address: _ 3 p 1 Q <br /> Phone: C7 <br /> O o <br /> FAX: F H �^ y N v3 v <br /> � m C v x <br /> Contact person: 'o ro 3 3 UR' �, N z W U <br /> a �c E✓A v, a A + ,o 60 <br /> Purchase order/contract(FGL quote number: pC4 2 f Z <br /> E F. pkv p 5 d W <br /> a <br /> Pre Log Required: yes no c a Z rn y 00 z d ° <br /> •a' c ; z 33 rn owe N w. v -ca <br /> SAMPLE INFORMATION �FCTION IN' <br /> O U cn t7 3 ... 'o .R C <br /> G ° GQ, rn u F d �^ <br /> Sample Location/Description Date Time °d' 3 3 3 v a <br /> Number Sampled Sampled Z 3 03 m a <br /> I , <br /> SECTION VI <br /> REMARKS Sl-'C'l[ON V CUSTODY <br /> Relinqu s b dub' to the s and c/oyn,�dfiti�ns an[he reverse of this decd nt: <br /> ��/� Dale , y / lime f//•, Relinquished by: Date Time <br /> Received by: I/I Date J-2"-114'15me `�' Received by: Date Time <br /> Relinquished by: Dale Time Relinquished by: Date Time <br /> [7 - k-1 <br /> T XI Received by: Date Time Receiwd by: Dale Time <br /> -+ CORPORATE OFFICE&LABORATORY OFFICE&LABORATORY FIELD OFFICE <br /> P-O.Box 2721933 Corporetion street 250o Stagecoach Road Visalia,California <br /> Santa Paula,CA 93061-0272 Stockton,CA 95215 Tel:(209)734-9473 <br /> TO:(905)559-09EO Tel:(209)942-0 191 Mobile:(209)737-2399 <br /> FAX:(8O5)525-4172 FAX:(209)942-0423 FAX(209)7348435 <br />