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IROI`IMEI�ITAL IN OF CUSTODY <br /> D ANALYSIS REQUEST DOCUMENT <br /> ��Mm moll <br /> f ;' • = f Rush Analysis Yes S Days — 2 Days— 24 hrs <br /> Client �. U b( pt C S Samplu(s) A Subjecttosurcharge <br /> Customer Number QgIQC report required yes Y no <br /> Address O Cc I 1"! <br /> Sa/cc tw)f P/� Comp Sampler Setup Date Time She Fiixrn required Y� J no <br /> Phone l /��� 7 7z— 4 l Lab number 533b <br /> Time Mileage <br /> FAX 7� ��� <br /> Lab Loc SP ❑ STK ❑ VI ❑ ❑ <br /> Projectname Q Ile ru rr-- <br /> Contact person <br /> Billing Inf ion <br /> Name !_[ (1f drfferent from above) IRS <br /> �j $ <br /> Address r Er <br /> 9S2,20 z <br /> Phonc <br /> FAX 3 � V z <br /> Contact person G! SOU CIA � 0 <br /> 1 <br /> Purchase order/contract number fi V <br /> racz F-- Z 0K61 1W IVAN I <br /> rIl G � � � � v <br /> r F C" *12 , + C <br /> Satngk Locationmescription Date Time <br /> Nu <br /> Sampled Sampled x `-�- <br /> 8 f r 09!Z 11x <br /> _ <br /> if v f 1 �C <br /> I1 0924 I 6 S <br /> w _ r 100 r1 J5s �l <br /> ,rj�r n —�� t �OSQ � ► <br /> i <br /> ao <br /> n <br /> N tlOI GC h lit 11 utatsrdbr' Time <br /> tm s Recel.A Or <br /> limDave Tune <br /> a <br /> S Rd Dasa e tteliogvdalved by Dace Min <br /> 4 <br /> Received by prte Time Racdved by paveFIELTime <br /> er <br /> OOtiPOtiA7E OFFtCH k t.ABORAT AT O Cx&LAB0 RY ViNalD OiF7 <br /> PO Bac 272!933 Carpor+cioa Stteet 2300 Sia wcli Road Tel ( C 734-9 a <br /> Santa Paula.CA 97061-0272 Stocttan CA 932!3 Tel (M)734-9473 <br /> Tal.a Pa s.CA 9 0 Tal.(209)942-01 942-0191 Mobile(209)737 2399 <br /> FAX fRr)659-Mi7, PAX r7m)wn4" FAX(209)7349435 <br />