Laserfiche WebLink
ORDER ID # S-S 7C) ' j � 2527 FRESNO STREET ' <br /> iA90 N1TORIES INC . FRESNO, CA 93721 <br /> (209) 268-7021 FAX:(209) 268-0740 <br /> AIN OF CUSTODY/ANALYSIS REQUEST <br /> ' REPORT TO: INVOICE TO: (OTHER THAN CLIENT) COPY REPORT (Circle One) <br /> ATTENTION:-. <br /> ATTENTION: s <br /> = State Dept. of Health )DOHS) <br /> ' NAME: NAME: �_ 1 <br /> u V ]- <br /> i T t w Fresno Madera Mariposa <br /> ADDRESS: <br /> ADDRESS: <br /> Tulare Kings Merced Kern <br /> PHONE: OTHER: <br /> FAX: CONTRACT I PO # <br /> COMMENTS BACTERIOLOGICAL SAMPLES ONLY PROJECT INFO: <br /> c �1 1-JA yam D" PUBLIC ROUTINE <br /> SURFACE WATER REPEAT <br /> CONSTRUCTION REPLACEMENT PRJ#� <br /> OTHER OTHER MGH'7 �45 <br /> PRIVATE ANALYSIS REQUESTED <br /> TURNAROUND REQUESTED: (rude oriel <br /> ROUTINE RUSH ;Specify Date): q1 1 <br /> PEED" (PRINT NAME): \�rAM <br /> 1GNATURE: �� ` A ) I <br /> TYPE KEY Drinking Water DW 'Waste Water-WW Aqueous Aa.` W <br /> Sofid/Sell-SL Other-O{Describe in Comments) r <br /> SAMPLE IDJ <br /> SAMPLED TYPE <br /> DATE TIME <br /> 0 YV+W d 1�1� <br /> 3 a v <br /> i <br /> V V -- <br /> - I <br /> RELINQUISHED BY <` COMP"y , DATE TIME RECEIVED BY; CaMPAM'.; <br /> 4 XJ^, <br />