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i <br /> CHAIN OF CUSTODY APPL, Inc. <br /> RECORD 4203 W. Swift Avenue, Fresno, CA 93722 <br /> Phone: (209)275-2175 <br /> Fax 209 275-4422 <br /> Project NamelNumber Sampler(Print) rJ Analysis Requested-Whod Number Date Shipped: <br /> Ae—L iCarrier: 5F—v) i"X <br /> Purchase Order Number Sampler(Signature) Waybill No.: <br /> zZt I V--w�',F L�`�.-"'� �-f-�'� �j Z •� Comments: <br /> Sample Identification Cabtd Ct. oMc od M,wz wntalne s w -zJ <br /> 1yLV'1 to lG Z �. <br /> Ito Z A-i,�i_. — / A — IUB ill ,�iz 11 i�` `' Z.. �i_1f.Sll�- 1�. Ji'kg.- <br /> to <br /> � m <br /> o � <br /> 0 .9 <br /> � <br /> P^ N <br /> U <br /> a[O <br /> Shuttle Temperature: Turnaround Requested: Sample Disposal: V •c5l <br /> 'J« -Toe/Ccdi-Hlh?SI-C WATEL <br /> Standard(2-3 week) ❑ One week '$12448 hour ❑ Return to client ❑ Disposal by Lab(wo-day n mom) <br /> Relinquished /p Date . Time Received by: Relinquished by: Date Time Received by: <br /> �u ��-�i/ t2�� <br /> Relinquished ter: Date Time Received by: Relinquished by Date Time Iv at y: <br /> Report to: Bill to: -TU <br /> TU <br /> TZ� <br /> Phoned SIG :F � -Z FAWG 12,h - i4-7t <br /> White: Ftbtum to client with report Yellow: La tory Copy Pink. Sampler <br /> c.o.c. N° 2022 <br />