Laserfiche WebLink
T7iE <br /> zR' # �' t' TwINING 2527 fSN0 STREET y <br /> If- <br /> L 4 B O R A T 6 R I E 5, -INC <br /> FRESNO, CA 93721 . <br /> Jlv- <br /> (209) 268-7021 FAX:(209) 268-0740 <br /> CHAIN OF CUSTODY/ANALYSIS REQUEST <br /> ,k=I <br /> REPORT TO: INVOICE TO:{OTHER THAN CLIENT) COPY REPORT (Circle One) <br /> ATTENTIOI6 'tt�J ATTENTION: 5 Q . State Dept. of Health (DOHS) ' <br /> NAME r NAME r �� Fresno Madera Mariposa I <br /> y� C �c1�(h ^1 S - ADDRESS: <br /> ADDRESS: . <br /> Tulare "Kings Merced Kern Y <br /> (Nf 14 rw-S e <br /> OTHER:' <br /> PHONE: <br /> �I <br /> FAX: y; CONTRACT 1 PO # <br /> COMMENTS 1- \—Sk V ►1� i.r11V 1 '. BACTERIOLOGICAL SAMPLES ONLY PROJECT INFO: <br /> ��^ n�[ �` V1 ` • n <br /> PUBLIC ROUTINE I v <br /> �� ntf �� �' �•P r SURFACE WATER REPEAT / 11 /� _! I <br /> CONSTRUCTION REPLACEMENT PRJ O? - <br /> OTHER OTHER MGR: <br /> PRIVATE ANALYSIS REQUESTED <br /> - - . ANAL - <br /> TURNAROUND REQUESTED: (drde one) <br /> ROUTINE'-,! RUSH (Spedty Date): � 7r' <br /> ROUTINE'-,! <br /> SAMPLED BY (PW ME): <br /> SIGNATURE: <br /> TYPE K£Y #]nnlang Water Waste Water WHl1 ¢AQueous AG <br /> So)idfSai) SL Other O{Describe m Con•�fients) r G <br /> SAMPLE ID SAMPLED TYPE <br /> DATE TIME <br /> Ll Z-T <br /> 10 H <br /> �•- SP - - ; n 4t hi <br /> REE IAlQUf5liEf?BY... CON)PAhIY, '. DAVE. TIME RECIIYED BY .COMPANY <br /> 4, <br /> g4g <br />