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' MOORS TWINING CHAIN OF CUSTODY/ANALYSIS REQUEST <br /> 2527 FRESNO STREET•FRESNO,CA 93721•PHONE(559)268.7021•PAX:(559)268-0740 <br /> ' ANALYTICAL CHEMISTRY DIVISION WORK ORDER #: <br /> CALIFORNIA ELAP CERTIFICATION#1371 PAGE__ OF <br /> REPORT TO: o INVOICE TO: o REPORT COPY TO: REPORTING: <br /> ATTENTION: ATTENTION: ❑ STANDARD FORMAT <br /> NAME:KQv4�7 D WRITE-ON (STATE FORM) <br /> NAME: <br /> V %GEOTRACKER/COELT(LUFT) <br /> ADDRESS, Gd /� UJ=�/c ADDRESSi D PDF D SPREADSHEET <br /> 6V 6 V ❑ County DHS I <br /> ' Qawo�a Conon d a O Environmental Health Agency; <br /> PHONE, PHONE: <br /> / - 852 'Q//8 ❑OTHER: <br /> iA%: FAX: <br /> 4 G �SZ-91. Z 61j,"IID 7-at177oo57yy <br /> SAMPLE INFORMATION SAMPLE TYPES: PROJECT INFORMATION <br /> SAMPLED' EY'PRINT': SOLID; CONTRACT/P.O.NO..�• ""-At BS-BIOSOLID <br /> SIONATURF: CR-CERAMIC PROJECT: <br /> SL-SOIL/SOLID FcrrR e-,r V't_L" c 6 e. �y i <br /> LIQUID; PROJECT NUMBER: <br /> D PUBLIC SYSTEM D ROUTINE DW- DRINKING WATER leT t76_O� <br /> GW•GROUND WATER <br /> D PRIVATE WELL (71REPEAT pROIECT MANAGER: <br /> OL-OIL <br /> D OTHER D REPLACEMENT SF-SURFACE WATER p re�✓y <br /> ' TURN AROUND TIME: ❑ RUSH,DUE ON: ST-STORM WATER WW-WASTE WATER ANALYSIS REQUESTED <br /> TANDARD <br /> NOTES ON RECEIVED CONDITION: ,l <br /> L tbt O Q \ <br /> ' p ❑ CUSTODY SEAL(S)BROKEN ❑SAMPLE(S) DAMAGED <br /> B a j IS a <br /> U ZI <br /> 'p'ON ICE D AMBIENT TEMP. D INCORRECT PRESERVATION Ov <br /> y <br /> .46 <br /> } <br /> E CLIENT SAMPLE ID DATE TIME TYPE 4- <br /> r req \4 X - <br /> (�w K-1 /2 <br /> le/2Y/t/ 00 r/.ro <br /> lh.Lv� I k3S <br /> �hW - ( � 1N4f <br /> �y <br /> Tr-r IGvn l'C._ JOVE ' <br /> 1 <br /> 1 <br /> COMMENTS/ADDITIONAL INSTRUCTIONS: <br /> RELINQUISHED BY //COMPANY DATE TIME IV"Y Y COMPANY <br />