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10 � FF'I I!1 H!''1L DF. !151iT. !_!!fIT Ti. 9-19107'=1401.� P.[i <br /> � •'1�5 -1• P�"" _ � �� V`AML <br /> OIL x <br /> AUTEJGRj.?-AT-1CN REQUF-,9T FORM AU) <br /> 4t=A of �,i1T�1 3efrices `. � - - <br /> �sar� lbieritRLat i.�xatur <br /> Part A ;tc txs comp l r3 t:"ed R aweS L or - PLEASE PRINT) <br /> priorlty L.rvei <br /> Requey"ar's .maze AIA+ L (PL S <br /> sr <br /> ZSV'P 8escion i Un1 t <br /> 7PAZj 3 u 'Ys 275?' <br /> Phone Nuxber :j ) r 7 78 <br /> i <br /> BACK-Z]P ft.P3T0� Tei: ( � ) K g - 7 ;7 <br /> { <br /> wrna.l_vticad ReQUrsto P1rs4u0d ;utci6 i a"WIt r>5"W-40 <br /> } # of Spy. �# of S�V} # of Spi <br /> �lT:is Spla 4`9Pe Az%slgais Sgla Aaa�va3g els ;Type <br /> 8Q e <br /> - - - — 8020 �— <br /> i --- -_� 8240 13eta1s <br /> ___ _ Falatiles _ <br /> j- <br /> 3�tvals.Qpe��zo1 <br /> PQs�iciriePs <br /> A.g_T <br /> op-pen wt Herbicide <br /> s. <br /> PAY Ext.CT-`S- <br /> . 3crecn�L i�_ f <br /> Expected Date of Saaples3 Az-rival St <br /> Axr yaig oh}cat�-ve �'a$te ,^.baracY u. b. Tre-atnent 9tds. <br /> (eimle =e) c. D-ri.nkg.Tu O Std. d. Others <br /> Le-tection biwit gftquiz 0m6nt-2 - <br /> (f3 diff. rm oewabliow <br /> past D ; be wmFIete'd by <br /> AutYaorizatiaa fiber ( ) —11 <br /> ETZ!Lel <br /> Rrpiratiasn DateInc. <br /> - Name �u t„aboratorles, <br /> - Adldress. 6 0 Florin Perking Rd. <br /> Lab to Receive SPI-8 $ararnento, CR 95828 <br /> 4g � :-sig Z.pQetQd in rseCz iaa 1 2 uC iJic <br /> (1 ) Eenrmbe_ to list <br /> 8snrp � Anal�s i a R nest ($AE; <br /> for*- -i�ra�2 3/TZ <br />