Laserfiche WebLink
CHAIN-OF-CUSTODY `� `, Page of" <br /> Laboratory Information Original Copy of Report Sent To: Special Instructions: <br /> Laboratory Soil Control Lab Company: Forward Republic Services <br /> Address: 42 Hangar Way:Watsonville,CA 95076 Contact- James Dutra <br /> Phone:(831)724-5422 Fax:(831)724-3188 Arlt+ressI- 9999 S.Austin Road <br /> Person from your company to be contacted with questions Address2 Other Anal ses Re uested Lab Use Ont. <br /> Name: James Dutra City,St.Zip Manteca Ca 95336 Storage <br /> 1= <br /> Phone#s: (209)507-1421 Phone: 2095071421 Fax: 0 Location. <br /> Information on facility that the sample was drawn from E-mail Reports To:(in box below fill In up to 3 address) 0Y f=reezer <br /> Company: Forward Republic Services idutraCakepublicservices.com g <br /> M <br /> Contact: James Dutra cearbaial re ublicservices.com a Refrigerator#t: <br /> Addressl: 9999 S_Austin Road Invoice Sent To: <br /> >, o <br /> Address2 Company: Republic Services Shelf#: <br /> City,St.Zip Manteca Ca 95336 Contact: Christina Carbajal m <br /> CD <br /> E-mail Addr: Addressl: 9999 S.Austin Road c a Shipper: <br /> Phone: City,St.Zip: Manteca Ca 95336 n t o <br /> cc <br /> Sampler'sPrinted Name: James Dutraca <br /> PO#: q y (� ami 11 <br /> �'®� 5 Q <br /> Sample Date&Time Complete Compost Pkg M 0 Sample <br /> 06 0 <br /> Identification Sampled STA No STA C: U <br /> U ch Condition <br /> Super Compost qjzo/o 151X X x I x <br /> *Optional:Help us in our research. Please list your feedstock and approximate%used,process,and age of material. Thank you. <br /> Manure type&% Biosolids% MSW% yard waste% Foodwaste Industrial type&% Other type&% Comp. Process Age of material <br /> Sample 1 <br /> Sample 2 <br /> Sample 3 <br /> Sample 4 - C­ ` X <br /> Sample 5 <br /> �J <br /> Released By Si nature and Printed Name). Date/Time: Received By(Sin d Printed Name): Date/Time: <br /> e 9 23 1510 7 / <br />