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" -'•• •• •• •• ..r. w. �w .wv ue.poneLUYJ . pYYCiW NI YJJJL r lLV7! JL/-TVJV // / <br /> .... _ •C w <br /> Date: /� r �_ D ROE R F O R W D R K Orderp �� <br /> am <br /> Time: p■ By: _el6au <br /> CLIENT <br /> to S' - 3046 Contact Or A?C,L j cCr�kzr3 <br /> Client: _.t1,:1.� [t�L� ��pc ��( Phone: OZ6.3jj - i0 Representative: J <br /> Address. City. state: Zip: <br /> BILLING1 <br /> °��1% n Purchase Order <br /> (t� Bi I To: Cncn Phone: ( 2_/_ - 3/00 /02/-rjrj Fp <br /> 0 i F" Address: 2;2 2 &Je`&Zr Azle- �61,ej `on7 State: (4/�Iip: _9;:5,2 02 <br /> 7_ _ �_ City: _ ` --- <br /> Payment: :_: Cash f___ J/----_ :_I Check f— — :X: Bill 1_I Other: <br /> SAMPLE L0CAT10N / PROJECTI <br /> c�rrliy 1.4:�L.c ltt-L1Li� , <br /> Address: r1� C City: �------ State: _ Tip: <br /> Cross - <br /> Street: U.O. Tank Removals: Number _L Sire5vv Gals Type S�rL <br /> Copy To: _..LLt) r�' i n L-LLClr NOTE: Attach Any Special Instructions Or Diagrams As Necessary. <br /> ewtiCy f'�1:Lcu u e:ns tvi; »�tiz <br /> �r ;ii. .0 'cam cwt !S'/c; S H E U U3L I N fi71�r✓e Lst dkebn .CA <br /> Sample: 'Y,'1 One Time Only 11 Weekly 1_: Monthly 1_I Auarterly :_: Other: �_ Start Date: A) A'al 8_y <br /> _ L <br /> Results: Routine 1_1 Silver Rush 1 : Gold Rush <br /> j Time: 10 Workdays 5 Workdays _ _ T2 Workdays <br /> r Rate: ! List Price ! 1.5 x List (Needs Lab Director's Approval) ! 2 x List (Needs Lab Director's Approval) <br /> Client Contact/Verbal Results: _—_—_____- Date: Time: <br /> Lab I.O. f Test Code Test Description/Method Comments List Price Discount Costs Incurred <br /> C. evJ� f `.5 I f <br /> 5403 Tera 5DUTH oic ) f� ,� I f <br /> f Z f <br /> $ I f <br /> f i f <br /> f I $ <br /> Digestion, Extraction, Filtration, Or Any Other Special Handling Per Sample f I f <br /> i <br /> Li t�&C t-a-p (2!55r-1-3:;-,16 SC'/S� 3a ro) Field Service Charges fIN w <br /> ! D Total Other Charges f <br /> TOTAL JOB COST <br /> File: OFNPGLFRM Page 1 of Rev: 05/04/1909 <br />