Laserfiche WebLink
nrE �`may <br /> ORDER ID # TWINING 2527 .iESNO STREET <br /> LABORATORIES . INC. FRESNO, CA 93721 <br /> (209) 268-702 FAX:{209} 2fi8-0740 <br /> %kAIN OF CUSTODY/ANALYSIS REQUEST <br /> REPORT TO: INVOICE TO: (OTHER THAN CLIENT) COPY REPORT {Circle One} <br /> ATTENTION: ATTENTION: State Dept. of Health (DOHS) <br /> NAME: NAME: <br /> Fresno Madera Mariposa <br /> ADDRESS: - ADDRESS: <br /> _ Tulare Kings Merced Kern <br /> OTHER: <br /> PHONE: <br /> FAX: CONTRACT 1 PO # <br /> COMMENTS BACTERIOLOGICAL SAMPLES ONLY PROJECT INFO: <br /> PUBLIC ROUTINE <br /> F - <br /> SURFACE WATER REPEAT J r <br /> CONSTRUCTION REPLACEMENT PRJ#: ;" ~ <br /> OTHER OTHER MGR.- <br /> PRIVATE <br /> GR:PRIVATE ANALYSIS REQUESTED <br /> TURNAROUND REQUESTED: (cirde one) <br /> -'ROUTINE RUSH (Specify Date): <br /> MPLED BY (PRINT NAME): - <br /> SIGNATURE: I ^� <br /> TYPE KEY: Drinking Water-DW Waste Wafer-WW Aqueous-AG <br /> Solid/Soil-SL Other-O (Describe in Comments) ~ <br /> IDx SAMPLE M SAMPLED TYPE <br /> DATE TIME <br /> r J� ' /t /r,` <br /> i. <br /> .%firLl <br /> `/ �r• r <br /> RELINQUISHEDBY '< COMPANY DATE TIME:: RECEIVED81L; COMPANY <br /> r <br />