Laserfiche WebLink
i <br /> I <br /> t <br /> . I <br /> ` <br /> Client SiF A/l/c,4?.) <br /> �walffornia SAMPLE CHAIN OF,' <br /> F q JSTODv RECO�;i) Add � <br /> \ Address <br /> / Wale L®Ys (Please print) <br /> Phone No. X1 '7, .-J` <br /> .J %•55r'� ,I <br /> P.O.Box 4249 Ship samples to: 0225 Proj.Mgr.lContacl I <br /> 14odesto,CA 95352 1430 Carpenter Lane Pink•Field Copy <br /> (209)527 4050 Modesto,CA 95351Record_,/ of White and Yellow_To Laboratory with Samples � <br /> YeIIOW•Retum to Client <br /> PROJECT/St-TE NAME: J <br /> ANALYSIS REQUESTED I' <br /> TAT <br /> PROJECTlCONTRACTIPO NO,: <br /> i <br /> L 'il <br /> • �;fa4 <br /> NAME OF SAMPLER: <br /> REMARKSlSPECIAL INSTRUCTIONS <br /> AB USE ONLY SAMPLENUMBER <br /> . N <br /> LAB I-D. I.D. DATE TIMEO ¢ COFN• <br /> U TAINERS75-1 v <br /> I\ ` �• <br /> I <br /> fiE1_/ �'// r r1�isGir Ni S .R <br /> �I <br /> i <br /> � d <br /> RELINGUT§HED,B SIGN) DATEITIME <br /> RECEIVED� ED BY SIGN d!� / DATE/TIME RECEIVED FOR LABORATORY j <br /> BY ISIGNI:­ DATEITIME_1,7 <br /> • / fj <br /> RECEIVED: C0 <br /> LD AND INTACT OTHER PRESERVATIVE ;-YES <br /> X COTHER: <br /> TURN AROUND TIME: <br /> SHIPPED VIA: 7—,FED X +SLIPS COTHER: SHIPPING ORDER NO.: 1:24•Hr <br /> C2•Day --5-Day ir10-Day <br /> r <br /> x <br /> w. I <br /> i <br /> fli <br />