HomeMy WebLinkAbout[Untitled]_55-58TWINING
ANALYTICAL CHEMISTRY DIVISION
CALIFORNIA ELAP CERTIFICATION # 1371
REPORT TO:
CHAIN OF CUSTODY/ANALYSIS REQUEST
2527 FRESNO STREET • FRESNO, CA 93721 - PHONE (559) 268-7021 - FAX: (559) 268-0740
WORK ORDER #0
PAGE 0;
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ATTENTION.
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ATTENTION:
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❑ WRITE-ON (STATE FORM)
❑ GEOTRACKER/COELT (LUFT)
❑ PDF 0 SPREADSHEET
❑ County DHS:
❑ Environmental Health Agency:
0 OTHER:
NAME.
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NAME:
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ADDR
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PHONE:
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PHONE:
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SAM INPORMATION
SAMPLE TYPES:
C/ PROJECT INFORMATION
CO . NTRACT/P.O. NO.:
SAMPLED BY PRINT):
SOLID:
ES - BIOSOLID
SIGNATURE:
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CR -, CERAMIC
SL -- SOILISOLID
PROJECT:
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PROJECT NUMBER:
❑ PUBLIC SYSTEM ❑ I R 0 C6 1� E_
LIQUID:
DW - DRINKING WATER
❑ PRIVATE WELL ❑ REPEAT
GW - GROUND WATER
OL - OIL
PROJECT MANAGER:
❑ OTHER ❑ REPLACEMENT
SF - SURFACE WATER
ANALYSIS REQUESTED
TURN AROUND TIME; ❑ RUSH, DUE ON:
ST - STORM WATER
WW - WASTE WATER
❑ STANDARD
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NOTES ON RECEIVED CONDITION:
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A ❑ CUSTODY SEAL(S) BROKEN ❑ SAMPLE(S) DAMAGED
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CLIENT SAMPLE ID DATE
TIME
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COMMENTS/ADDITIONAL INSTRUCT S:
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RELINQUISHED BY COMPANY
DATE TIME RECEIVED BY COMPANY
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43—
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