HomeMy WebLinkAboutDEQ-CFW_00022402SAMPLE COLLECTION AND CHAIN OF CUSTODY RECORD
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721026460 (Gran)1266633760 (Wank)
Wisconsin 13ATCP ID
105-000330 ( ran) t 105-000479 (Wank)
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NORTHERN LAKE SERVICE, INC.
Analytical Laboratory and Environmental Services
400 North Lake Avenue m Crandon, W1 54520-1295
Tel: (715) 475-2 7 77 . Fax, (715) 475-2060
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i. TO Est - T A,EGLIUN OI�?Y REQUiREPY�+I NTS. THIS FORM MUST PE COM?LETED IN €3EMIL AND Lh'S. L€. MED iN THE Ci:Cii.Er� (,0N- T;R INfNG `I'H SAF3,:PLES DESCRIED.
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2. PLEASE USE ONE i. NE PER SAMPLE, NOT PER BOT T 11.
3, RETURN THIS FORM WITH SAMPLES -' ii,IENT MAY ' KECP YEL LOW COPY,
4, PARTIES COLLECTING SAMPLE, LISTED AS REPORT TO AND LISTED AS INVOICE TO AGREE TO STANDARD TERMS & CONDITIONS ON REVERSE,
DEQ-CFW 00022402