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�■� Its 1 ■� tt� iw1 IFttt� 1111111111Wttttl� tttttttttt� <br /> .CIVANALYTICAL LABORATORY Ir �3 ) 1c, CHAIN OF CUS DY <br /> Location 2333 Shuttle Drive, Bldg 9081909, Atwater, CA 95301 Certificate No 2079 <br /> Mailing Address 2333 Shuttle Drive, Atwater, CA 95301 PAGE-OF <br /> 7 <br /> Phone (2091384-2930 - Fax {209) 384-1507 <br /> Customer' REQUESTED ANALYSES Metth�od of Shipment <br /> Address 4bD � # u m N 1., CIL�c_IL� E <br /> City/State/ZIP z <br /> Notes <br /> Phone ! FAX wi. 1 � mProt # IPO # CCL o <br /> 110 <br /> o <br /> Report Attention r n a <br /> Sampler Signature a $ 32m I w <br /> Printed <br /> q <br /> Z <br /> Lab ttN SAMPLE ID DATE TIME DESCRIPTIONILOCATION 011 OBSERVATIONS/REMARKS <br /> C w S I I1 <br /> L S <br /> 1 4 POTRY <br /> `UOD CONDITIR , APPROPRIATE <br /> HEAD SPACE ABS PST CONTAINSS <br />{ Total number of conlainers submitted to <br /> i ature Printed Name Date Time Company Name 3 the laboratory <br /> Relinquished by 1 74 Note All special requests(e g quick <br /> Received by 1Ile,d--Lz,c n Iola rC 1 A- turn times)must be cleared through <br /> authorized laboratory personnel <br /> Relinquished b <br /> Received by <br /> _ Relinquished by RESULTS DUE <br /> Received by VERBAL r WRITTEN <br />