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Calscience Environmental Laboratories, Inc. � S� CHAIN OF CUSTODECORD <br /> SoCal Laboratory Q NorCal Service Center ` 1 <br /> 7440 Lincoln Way 5063 Commercial Circle,Suite H �V l� Date \ 's\! ©Z <br /> Garden Grove,CA 92841-1427 Concord,CA 94520-8577 <br /> (714)895-5494 (925)689-9022 2_ Page of <br /> LABORATORY CLIENT: CLIENT PRZ7JEG�T7NAME/NUMBER: P.O.NO.: <br /> ADDRESS: ` 0 %~ O F — -2,6 <br /> `�--� s v PROJECT CONTACT: LAB USE ONLY <br /> CITY STATE ZIP 11�� ��-�` 0 0 — 11 El1-1 El <br /> SAMPLER(S):(PRINT) COELT LOG CODE COOLER RECEIPT <br /> TEL:`a[ E-MAIL:`bc1Sf—5749 !p A—It-4 T— C-A US CA E0Se'' ,ZP- TEMP= °C <br /> TURNAROUND TIME: <br /> j <br /> El SAME DAY E124HR F148HR ❑72 HR STANDARD REQUESTED ANALYSES <br /> II SPECIAL REQUIREMENTS(ADDITIONAL COSTS MAY APPLY) _ <br /> ❑RWQCB REPORTING FORMS COELT EDF L.ZO 5 S4- <br /> v <br /> SPECIAL INSTRUCTIONS: ° ` U CEJ <br /> ��Na P� OflR ( 'VZ,MA t� 'vl� � RP`s- o o CD <br /> o � <br /> m <br /> o CD ¢ 5 v o " o <br /> U m ` 0 o Q ^� N <br /> U U m o o m Q v <br /> D] � Vi d N N O C.0 O <br /> av Cn <br /> C6 d N O C7 6 <br /> E!, N }v <br /> LAB FIELD POINT NAME SAMPLING NO. _ _ = Lu v o m ¢ j v = 4 <br /> ji USE SAMPLE ID MATRIX OF D D o H O X c > U z N0 C <br /> ONLY (FOR COELT EDF) DATE TIME CONT. F- r- t- m > O U cn a a 2 U > r <br /> I <br /> I. A (� "1 3 0 0 13 S Vel . <br /> II <br /> �I <br /> I <br /> II <br /> II <br /> u <br /> i <br /> C' <br /> I- <br /> CV <br /> �I Relinquish V (Signature) Received by:(Signature/Affiliation) Date, Time: -0D <br /> A--x t t� Ito k I joy i <br /> Relinquished by:(Signature) Recei by: i nature/Affiliation) Dat': Time: <br /> ji Relinquished by:(Signature) Received by: ture/Affiliation) Date:' (/ - Time: <br /> I � <br /> DISTRIBUTION:White with final report,Green and Yellow to Client. fJ5/01/07 Revision <br /> Please note that pages 1 and 2 of 2 of our TICS are printed on the reverse side of the Green and Yellow copies respectively. <br /> i <br />