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SII <br /> CHAIN OF CUSTODY APPL, Inc. <br /> RECORD 4203 W. Swift Avenue, Fresno, CA 93722 <br /> Phone: (209)275-2175 <br /> Fax (209)2754422 <br /> Project Name/Number Sampler(Print) Analysis Requested/Method Number Date Shipped: G ) ( r <br /> A1;L. Carrier: <br /> Purchase Order Number Sampler(Signature) =' Waybill No.:f5C,)l el-74q-05` <br /> 'Z -L'Z Comments: <br /> 4; <br /> mre flryre ber Of j L <br /> Sample Identification Cdierud coli Matmc oonainem <br /> IZf�� Ale,- It VUA <br /> _t 124' r in <br /> a <br /> o � <br /> r� <br /> o ) <br /> to <br /> U` <br /> Shuttle Temperature: Turnaround Requested: Sample Disposal: <br /> ❑ Standard(2-3 week) ❑ One week 2448 hour ❑ Return to client ❑ Disposal by Lab r44.y retenu.) <br /> Relinquished by sampf�r Date Time Received by: Relinquished by. Date Time Received by: <br /> Relinquished by: Date Time Received by: Relinquished by, D to Time Rat lab by <br /> 7Z <br /> Report lo: Bill to: F70 <br /> L"-J AL -J AT- el,1�tj J% <br /> Phone#:c 16 �� s' t:ci FAXlX t � T,-1, 4-t <br /> White: Return to client with report Yellow: Laboratory Copy Pink Sampler <br /> c.o.c. N° 2021 <br />