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Client City of Manteca <br /> Chemicalwasteallagelil@jlt' Inc. 2862 Address 1001 W. Center St. Manteca <br /> Phone No. (209) 239-8433 <br /> tAOW Western Region Laboratory <br /> Proj.MgrXontact Warren Shannon <br /> P.O.Box 4249 Ship samples to: <br /> SAMPLE CHAIN OF CUSTODY'RECORD WRL PO# 43917 <br /> (Please Print) <br /> Modesto,CA 95352 1400 Carpenter Lane Suite D <br />` (209)5271050 Modesto,CA 95351 Pink-Field Copy <br /> White and Yellow-To Laboratory with Samples <br /> Record�_ of Yellow-Return to Client <br /> PROJECT/SITE NAME: ANALYSIS REQUESTED <br /> City of Manteca- WQCF <br /> PROJECT/CONTRACT/PO NO: <br /> P.O. #43917 <br /> NAME OF SAMPLER: REMARKS/SPECIAL INSTRUCTIONS <br /> SANDY WILDS/WARREN SHANNON <br /> LAB USE ONLY SAMPLE a m NUMBER <br /> DATE TIME pp� OF <br /> LAB I.D. LD. U t7 CONTAINERS <br /> #8 sludge" 11/7 2:30Analyze Per Bid <br /> 3� s random gra) .m X 11 <br /> RE U HED BY(S ) DATE/TIME RECEIVED BY(SIGN) DATE/TIMECEIVED FOR LABORATORY <br /> BY(SIGN " DATE: /-- <br /> 5 RECEIVED: TIME: <br /> COLD AND INTACT OTHER PRESERVATIVE El YES �NO <br /> ❑OTHER: <br /> TURN AROUND TIME: '_/ <br /> ci.nDOGn vIn• GGn v —11oc nTuca• QW1001nir_nonGa n1n• r 24-Hr f 2-Dav 5-Dav Y 10-Dav <br />