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—— .a��J iityALl SIJ KI:�D6S I UOCUIYI6/V <br /> / a <br /> / A:a Rush Analysis(surcharge will apply): <br /> Client: Z Sampler(s) <br /> ms <br /> ❑New.Customer Customer Number: 3—IOq J 05 Day ❑ 4 Day ❑ 3 Day <br /> Address: 99 S..y S a.t/�qrn�� S!`- ❑ 2 Day ❑ 24 hour <br /> n[�r `7 s� J Comp Sampler Set up Date: Time: P pp y lab: <br /> Rush pre-approval b <br /> inital <br /> Phone: ::jj y — 3 S'717/ Electronic Data Transfer: yes no <br /> FAX: x'19 q — 3(c�'—�1L{ rime: Mileage: If yes,To:Stale Client tither <br /> Project name: C-��6in G1J LL�?2, )) ti,Se 'T�2..fF Labnumber: <br /> Contactperson:: ` aQ hh h ".r (j� /ls Gr mss. C4% I b5 <br /> g <br /> Billing Information(if different from above) a <br /> � u <br /> Name: o' U <br /> E 1i S <br /> Address: z 4' m <br /> s <br /> O <br /> Phone: U S 5 W 3a 0 u Z C <br /> 3 m y V w v ni <br /> FAX: u a o f t@ <br /> Contact person: �+ J �1 2 U .0 z ,frCr�F7jJ <br /> Purchase order/contmct/FGL quote number: D i2 /7 E L, V w 'e v W SS ZD <br /> Pre Log Required: yes no eo ° U Z L B ? 9rj Z Z <br /> G T O o ^ S t <br /> E vSAMPLE INFORN <br /> Sample <br /> Location/Description Date Time �. E $ o. 3 3 3 <br /> Number Sampled Sampled l= Z 0 <br /> o PV s <br /> 0 <br /> a <br /> m <br /> F <br /> H 9M R1 N CUSTODY <br /> Reli and by act sr ' Im Ne tem Wcwyitiam on the rtverse vfft dacuncm: <br /> Mu, J rote /3 Rclinquishal by: / Dote /�� , Trow <br /> Received by. TimeReceived by: Dam Time <br /> Relinquix Dae I Time Relinquished by: Dam Time <br /> Receivedby: Dam Received by: Dam Time <br /> \ CORPORATE OFFICE&LABORATORY OFFICE&LABORATORY FIELDOFFICE <br /> P.O.Box a.CA Capon+lion Sueel 2500 Su8mc hRoad Visalia.Califnmia <br /> Santa Paula.CA 9]1-072 Smcksoo,CA 95215 TeI1559)731-94 ] <br /> TO:(805)659-0910 Tel:R09)9a2-0181 <br /> FAX:(90)5254172 FAX:(209)W2M23 Mobile:9)73 -8435 9 <br /> FAX(559)J]A�BOS <br />