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THE TWINING LABORATORIES, INC. Project Name PG f ' - sroa mej se,eviee CeNp1c <br /> 2527 Fresno Street, Fresno, CA 93721 Address YAyo w{ST' 1­4A;r- <br /> (209) 268-7021 $Tock To 1 GA <br /> Date I" <br /> Page— Mchairltody and Analysis Request Record Mgr. !> "' TL# <br /> �of o —� J1 �� (t� <br /> Analysis Requested of <br /> Report To: Copies To: <br /> Client Name Pd YE - - Lab <br /> Due <br /> Address 96o O ST Cnk Date <br /> FXedNo 4e Expected Tur ro d: <br /> Contact Name Mikb SAVAGG CKRush ❑ Routine <br /> Phone I <br /> Contract/PO# Specify Time - <br /> SamplerName j49YHON0 AWYal ktg ❑ FAX# <br /> (pnn0 <br /> Lab Client Sample Sample g/Size/T e of Container <br /> DM Sample ID Date/Vmea Type yp �P/reservation/Handling: <br /> Iff <br /> '9X_ ..Si/I- & Rn <br /> rr .XS SG ea✓e xy V d(sMes -4. <br /> / l;vfe So/L x <br /> } <br /> Each hazardous sample submitted For Water samples,please Comments: (BILL TO IF OTHER) Dept. Initials Date/Time Location <br /> for analysis will be charged a hazard- check one of the following: 601 - <br /> ous waste disposal fee. Clients that ❑Drinking Water 602 - <br /> retrieve hazardous samples within 30 El Waste Water <br /> days of the analytical report date will ❑Ground Water(wells) 1G) t� <br /> be refunded any disposal fees. - ❑Surface Water(rivers,lakes) - - <br /> x 604 <br /> / <br /> Relinquished y: Delivered By- Received By: Received.By: C- <br /> Signature Signature ^'� w Signature Signature <br /> Pfinted �aC fl�j'✓ �/t Printed '�' 'h Company ` Company /(.V lt>t vel <br /> mpAny —7 �� Company - L Date/Time Date/Time 4 �30/ <br /> mate/Time 1 0o-foZ- I;1`f1M- Date/Time �' �n Log In Date/Time Log In Date/Time <br />