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' CALIFORNIA WATER LABS i P.O. S"0014249 a 1430 Carpenter Line - Suite 6 a Nodes..�.. i 95352 s (209) 527-4050 <br /> Dater -�-/Zj/- 0 R 0 E R F O R N 0 R K Order$ <br /> Times 1/ _1 d0 pe Byl <br /> C L I E N T I <br /> Contact Or <br /> Clients +�u11N__ £J % �. --_ Phone: (_ 1 ��l�- �1�1�� Represestitivts �K <br /> /- / _ % <br /> Address: _ IU77�� ���jZ City: ---- � States Zip: ------� <br /> I I L L I N 6 1 <br /> ' �� )�,, / Purchase Order <br /> Bill Tos �f� L�(/ Phones t-------1 ----- 0r Contract No. <br /> r <br /> .Address: __CG `�� i�!L 5 City: _— x�% Stites (44iip: ----__-_ <br /> Paysents 1_1 Cash f----.— Check f . iyi Credit Application :�f Gibes <br /> SAMPLE LOCATION / PR0JECTI <br /> AQdresss Citys --- _ :� States� Zi}s ---________ <br /> Cross —5q A-)K 1 s A--"C)vr-_�� <br /> Streets �___ U.S. Tank Removals: Leber Site ______ Gals Type <br /> ty: _____— NOTE: Attach Any Special Instructions Or Diagrams As Necessary. <br /> S C N E I U L I 1 6 1 <br /> ample: 1 One Tin Only 1—: Weekly :�1 Hoathly 1,1 Quarterly 1_': Othws Start Datesq_/ /4-/ 6 <br /> Results: 1 : Roatin :_1 Silver Russ 1_1 sold Rush <br /> o TIN: 10 Workdays 5 Workdays __________ 2 Workdays <br /> e Rate: $ List Price $ 1.5 s list (Needs Lab Director's Approval', 1 2 s List (Needs Lab Di►cckwls Approval) <br /> Lab I.B. $ Test Code Test Descriptioan(ethod Comments Qty List Price Discount Costs Incurred <br /> .yle .4� <br /> # 1z' <br /> f z t <br /> f t f <br /> s z s <br /> f s f <br /> f z f <br /> f z f <br /> Digestion, Extraction, Filtration, Or Any Other Special Handling Per Sample f Z <br /> Wt4wT e0 L4ICL fLC"RVEST field Service Char es IKZ <br /> f 5j <br /> Total Other Charges <br /> TOTAL JOB COST f <br /> rile! INTarF1.FRN Page 1 of 2 Rev: 05/18/1M <br />