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kABS <br />APPL, Inc. <br />908 N Temperance Ave <br />Clovis, CA 9361-1 <br />www.applinc.com <br />(Zze0 6 <br />CHAIN OF CUSTODY RECORD <br />Phone: (559) 275-2175 <br />Fax: (559) 275-4422 <br />coc@applinc.com C.O.C. 59346 <br />�2,a <br />Report to: PLEASE PRINT <br />Company Name: ihone: <br />Address: PO Fax6 <br />90-sCVILLC) CA- '75-W — <br />Attn: =off R V.S CA— <br />Em.�CI� <br />Invoice to: . PLEASE PRINT <br />Company Name: t7S�la-/+SSnL'�L?�=',S G. Phone:(g1 <br />Address: Po &IX 332 <br />Fax: <br />OS—Cv7 CX gtS66 <br />Attn: :Zo F J5R0SC i'— <br />Email: <br />Protect Namepumb r <br />L �tZf+k= 01''x" <br />(L L <br />Sampler (Print) <br />--� (]� ► -� as CA-� <br />Analysis <br />Requested/Method <br />Number <br />Date Shipped: <br />o <br />o <br />67 <br />Matrix <br />�! <br />(f) <br />Q <br />4 <br />W <br />Carrier: <br />Purchase Order Number <br />002—�~ <br />S ler (' ature) <br />Waybill No.: <br />Q <br />o <br />Comments: <br />Sample Identification <br />Location <br />Date <br />collected <br />Time <br />Couccted <br />Time <br />zom <br />-- VJ <br />07 -all <br />?C• <br />F3 5 Vt/ <br />t Z: 4-< <br />Z <br />x <br />Shuttle Temperature: <br />Tupiaround Requested: Check one <br />Standard 2-3 wk ❑ One week ❑ 3 days ❑ 24/48 Hrs. ❑ Other: <br />Sample Disposal: <br />❑ Return to client Wisposal by Lab (30 -day retention) <br />sampler: <br />VIinquished <br />to <br />Time <br />. Received by: <br />Relinquished by: <br />•Date <br />Time <br />Received by: <br />: <br />Date <br />Time <br />Received by: <br />Relinquished by: <br />Date <br />b r <br />Time <br />lot 30 <br />Receiv d at lab by: <br />c <br />White: Return to client with report Yellow: Laboratory Copy. - See reverse side for Container Preservative and Sampling Informatibn <br />:1 <br />I <br />