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California <br /> Water Labs <br /> FIELD AGREEMENT <br /> I, the undersigned, an authorized agent arlgent of <br /> COMPANY NAME <br /> am requesting the following tests . <br /> !> <br /> 5)" <br /> l <br /> CONTACT NAME <br /> signature nt last name) date <br /> TOTAL # OF SAMPLES 1 <br /> TEST (s) REQUIRED <br /> y 1 . -pig -�,% W0 -gi✓ i sacs m-Eot?6 . <br /> 2 . <br /> 3 . $ • <br /> 4 . 9• <br /> 5 10 . <br /> COUNTY REQUIRING TESTS �/�.CI �dQ GCS <br /> Ct2✓ REPRESENTATIVE <br /> gnaturei print last name) <br /> CWL REPRESENTATIVE <br /> date <br /> P.O. Box 4249 Modesto,California 95352 (209)527-4050 <br />