Laserfiche WebLink
CHAIN OF CUSTODY <br /> ENVIRONMENTAL <br /> Nl 1V I ROI�M ENTAL AND ANALYSIS REQUEST DOCUMENT 4RIGI NAI <br /> ` t Rush Analysis(subject to surcharge): <br /> .rient: C,_I— It°ia.� �i_ �55t+Z tete S rSaer(s) <br /> 0 New Customer Customer Number: <br /> ❑ 5 Day ❑ 4 Day ❑ 3 Day <br /> Address: _-- dos*+&ut t..�l+�( LOQ t___C t ❑ 2 Day 1:124 hour <br /> r Sampler Set up Date: Time: Electronic Data Transfer: yes no <br /> Phone: 6 7_3 7 0 <br /> Mileage: If yes,To:State Client Other <br /> FAX: 3���GJ <br /> Project name: Lab number; <br /> I <br /> Contact person: Dave- <br /> a <br /> r'Rilling Information(if different from above) <br /> ....Jame: ld <br /> 3 �4 <br /> Address: <br /> p p <br /> ]{ b 3 Q N <br /> z oPhone: <br /> FAX: U F rn0 <br /> Contact person; 3 3 Ux _ * Z W ao <br /> a a Fr a, <br /> Purchase order/contractlFGL quote number: c E v a ar v F <br /> U o a 8 W <br /> Pre Log Required: yes no on z y r' a z rO o Ill <br /> c d <br /> Sample Location/Description Date Time <br /> Number S plc Sampled F- z <br /> L <br /> C <br /> A <br /> R <br /> F° <br /> Relin hed by nd sub}ect to the terms and conditions on the rcversc of this/dacument: <br /> VYJ ry+ <br /> Date -11/00 Time 1� 1 • Relinquished by: Date <br /> Received by' Date IM Time„#...[.. eivedby: bale �Ttme � <br /> Relinquished Relinquished by: L'1WO Date Time <br /> Received by: Date Time Received by: (0-- 1— cxwc- Date 6 r? Time t <br /> - CORPORATtt OFFICE&LABORATORY OFFICE&LABORATORY FIELD OFFICE <br /> P.O.Box 272!653 Corporation Strew 2500 Stagecoach Road Visalia,California <br /> Santa ''19366t t c"cklon, "°^'r F 1r Iy' 1269)73 i <br /> 101nt L.� Lrwi r7r10I _ �..�I a �.E 1.�rr �+�+4.�=• r'111� QI <br />