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WORK ORDER <br /> CHAIN OF CUSTODY RECORD <br /> Alpha Analytical Laboratories Inc. • 860 Waugh Lane,H-1,Ukiah,CA 95482 • (707)468-0401 FAX(707)468-5267 DATE. ' 1`��9� PAGE_,�OF <br /> CLIENT'S NAME PROJECT MANAGER SAMPLE CONDITION ON <br /> ✓/9.t/G' iCov .L "_',� 1 V RECEIPT: <br /> STREET ADDRESS CITY STATE ZIP PHONE NUMBER <br /> C ^ e - V �+ COLD/ICED? <br /> PROJECT NAME FAX NUMBER i <br /> euqj7z-O ,� i ,�/ BUBBLES OR AIR SPACE? <br /> C NT AQ /PURCHASEORDER/QUOTE NUMBER iSITE CONTACT <br /> Ql(1� 5 / .H /, WERE SAMPLES PRESERVED? <br /> SIGNATURE OF PERSON AUTHORIZING WORK SAMPLED BY <br /> TERMS§gTED 0 SE SIDE OF <br /> ORM. -/ �� '� // D� 7/ �' / / <br /> SAINIRLE-NUMBER • • �• • BELOW, <br /> , "/ %�{•v�' 3 W /a is' AOa,"Z-q_ / r r / d d rI d <br /> (3 /s 1 d <br /> 3 S,-P. d I <br /> o,yoa s�ii.' 3 <br /> ii ✓ ✓ / / ✓ 1 ,, /ivy 0 <br /> REL OUI \�HED BY: RECEIVED BY: DATE TIME •• • • • <br /> (SIGNA Rt► �_ (SIGNATURE) <br /> ELINQUISHED BY: �� RECEIVED BY: DATE TIME /O i�A y <br /> (SIGNATURE) (SIGNATURE) �C/ <br /> RELINQUISHED BY: RECEIVED FOR SAMPLE CONTROL OFF <br /> (SIGNATURE) Ll <br /> LABORATORY BY: <br /> METHOD OF SHIPMENT AUTHORIZED BY: , SAMPLE DESPOSITION: <br /> t. STORAGE TIME REQUESTED DAYS <br /> U�� (SAMPLES WILL BE STORED FOR 30 DAYS WITHOUT ADDITIONAL CHARGES: <br /> SPECIAL INSTRUCTIONS d A N o d THEREAFTER STORAGE CHARGES WILL BE BILLED AT THE PUBLISHED RATES.) <br /> 6 /�`jq �)�6/ 30 rF -. /VCe f '9 1,6-, ��Po f L 2. SAMPLE TO BE RETURNED TO CLIENT? O YES ❑NO <br /> DRIVING TIME SITE TIMEL C3 TOTAL TIME HAZARDOUS MATERIALS ARE THE PROPERTY OF THE CLIENT.THE CLIENT IS <br /> 0 RESPONSIBLE FOR PROPER DISPOSAL OF HAZARDOUS WASTES.CLIENTS NOT <br /> PICKING UP HAZARDOUS WASTES MAY BE ASSESSED A�APPROPRIATE <br />