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CHAIN -OF -CUSTODY `� `, Page of <br />*Optional: Help us in our research. Please list your feedstock and anoroximate % used. Drocess. and aae of material. Thank you <br />Laboratory Information <br />Biosolids % <br />Original Copy of Report Sent To: <br />Industrial type & % <br />Other type & % Comp. Process <br />Special Instructions: <br />Sample 1 <br />Laboratory <br />Soil Control Lab <br />Company: <br />Forward Republic Services <br />Sample 2 <br />Address: <br />42 Hangar Way: Watsonville, CA 95076 <br />Contact- <br />James Dutra <br />Sample 3 <br />Phone: (831) 724-5422 Fax: (831) 724-3188 <br />Arlt+resst- <br />9999 S. Austin Road <br />Sample 4 <br />Person from your company to be contacted with questions <br />Address2 <br />Other Anal ses Re uested <br />Lab Use Ont <br />Name: <br />James Dutra <br />City, St. Zip <br />Manteca Ca 95336 <br />Storage <br />Phone #s: <br />(209)507-1421 <br />Phone: <br />2095071421 Fax: <br />1= <br />0 <br />Location: <br />Information on facility that the sample was drawn from <br />E-mail Reports To: (in box below fill In up to 3 address) <br />0Y <br />f=reezer <br />Company: <br />Forward Republic Services <br />idutraarepublicservices.com <br />Contact: <br />James Dutra <br />ccarbaial re ublicservices.com <br />cB <br />a <br />Refrigerator #t: <br />Address'!: <br />9999 S_ Austin Road <br />Invoice Sent To: <br />>, <br />o <br />Address2 <br />Company: <br />Republic Services <br />Shelf #: <br />City, St. Zip <br />Manteca Ca 95336 <br />Contact: <br />Christina Carbajal <br />v <br />m <br />CD <br />E-mail Addr: <br />Addressl: <br />9999 S. Austin Road <br />a <br />Shipper: <br />c <br />o <br />Phone:City, <br />St. Zip: <br />Manteca Ca 95336 <br />n <br />t <br />Sampler'sPrinted <br />Name: James Dutra <br />PO#: ! y5 o <br />®� <br />� <br />ca <br />a <br />Sample <br />Q <br />Date & Time Complete Compost Pkg <br />0 <br />Sample <br />ldeniification <br />Sampled STA No STA <br />06 <br />U <br />U <br />0 <br />ch <br />Condition <br />Super Compost <br />VZO Z 151 <br />X <br />X <br />x I <br />x <br />*Optional: Help us in our research. Please list your feedstock and anoroximate % used. Drocess. and aae of material. Thank you <br />N <br />Manure type & % <br />Biosolids % <br />MSW % yard waste % Foodwaste <br />Industrial type & % <br />Other type & % Comp. Process <br />Age of material <br />Sample 1 <br />Sample 2 <br />Sample 3 <br />Sample 4 <br />- ` X <br />Sample 5 <br />�J <br />N <br />