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CHAIN OF CUS , , <br /> ENVIRONMENTAL AND ANALYSIS REQUEST � r ORIGINAL <br /> ` u,", <br /> Client Rush Analysts 5 Days 2 Days 24 his <br /> r Sampler(s) :�2 Subject to surcharge <br /> Customer Number J 2 <br /> �C, Z-0 <br /> � QAIQC report regatred yes noAddress bo <br /> � 1 Electronic Data Transfer yes no <br /> — / <br /> / LZC y �>sJ�� Comp Sampler Setup Date Time If yes,To State_ Client Other <br /> O <br /> Phone _ 02 O 5 LS J—2/,* r7 �J <br /> Time �!S Mileage 2y Lab number r <br /> FAX <br /> Lab Loc SP ❑ STK ❑ VI ❑ ❑ <br /> Project name <br /> Contact person /1 a <br /> Billing information(if different from above) f aee f <br /> 3 1 <br /> Name — <br /> a <br /> Address x j v <br /> O 3 0 .. 1 a O <br /> La � 3 O m Z n`" {� Q ! <br /> Phone C7 o rA > Ir <br /> FAX d <br /> pe 3in� U z W pU <br /> Contact rson <br /> Purchase order/contlact/FGL quote number o {j iw ce 0 m f s aY f <br /> Pre Log Required yes no q Z A >. El— <br /> ^ x fr s {iI}�C <br /> 'a rel Y ~ ` ` <br /> O C A y Q v t� � W ,7 fQ r C <br /> o a 3 o a a,�ft C o <br /> N a t b <br /> Sample Location/Description Date Time o p <br /> Number Sampled Sampled z <br /> 2 Z <br /> 11M 11411,11 <br /> Relinquished by an to the terms and conditions on the reverse of tl�scQoeument <br /> 410, <br /> — Time/(/� ("�`(''^�` Relingwsbe Dace Time <br /> Received by �,..-....Date J'� �0 I r ` c) by Time Received Da <br /> n i^ <br /> -Aebjb ``�''Annl!RR Dass F `�f 1 Time Rehngws by Da Time <br /> r oU1�D <br /> lsWell Date Time Rxetved by Dote Time <br /> CORPORATE OFFICE&LABORATORY OMCE&LABORATORY FIELD OFFICE <br /> PO Box 272JB53 Corporation Street 25M Stagecoach Road Visalia califumia <br /> santa Paula,CA 93 Stockton CA 9521 �1 T Tel (209)734 9473 <br /> "(805)659 091{! Tel (209)942 01 OCT I � 5 1998 Mobile <br /> (209)737 2399 <br /> is <br /> FAX (90.5)525-41 V FAX (209)942 FAX <br />