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ENVIRONMENTAL AND OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> RFF'ORTINFORNIATION <br /> GOVI1 ,tj�/ 1�1 Rush Analysis(surcharge will apply): <br /> Client: V LC7 l.. S <br /> ampler <br /> ❑New Customer Customer Number. ❑ 5 Day ❑ 4 Day ❑ 3 Day <br /> Address: ❑ 2 Day ❑ 24 hour <br /> Rush pre-approval by lab: <br /> Time: � inial <br /> Phone: Electronic Data Transfer: yes no <br /> Time: Mileage: <br /> FAX: If yes,To:State_ Cl en he <br /> Project name: A� Lab number: <br /> Contact person my t'i zv 1 f�-' <br /> a <br /> Billing Information(if different from above) <br /> u v S <br /> Name: it p G1 <br /> Address: � <br /> V < — )s o 3 s=- cd z $ <br /> m3" O S <br /> Phone: U .o m e <br /> ? y Z C <br /> Is <br /> J <br /> C) ^o <br /> FAX: v <br /> Contact person: 0. * Z F <br /> Purchase order/contract/FGL quote number: <br /> U = O c ? E s a 0 0 <br /> Pre Log Required: yes no Z b y S Z Z <br /> 9 = / fli <br /> a U c Z C� r/ <br /> o <br /> I 1 iA ` c v t 2 a -" c F > v <br /> c c H v 3 0 $ <br /> Sample Location/Description Dale Time c n' 3 <br /> Number Sampled Sampled t; Z p' X <br /> 0 <br /> a <br /> m <br /> ..t <br /> F <br /> Rdinqui by an s cct so na arms an co itions on dsc avcrsc of islld mot: <br /> Da rl`V�imc ]f CJ Relinquished'. Dare Time <br /> Received by: Dai Zf V�mc ( Receivedb . Date Time_ <br /> Relinquishedby: Daa 2- U2em Relin 2. s Time C� <br /> Rcccived by: f Daa ime� Received 1 I Ti <br /> CORPORATE OFFICE LABORATORY O C LABORATORY FIELDOVVICE <br /> P.O.Box 21L853 Corporation Slrect 2500 Ssagccoach Road Visalia.California <br /> Santa Pwla.CA 93061-0'_1'_ Stmbmn.CA 95215 Td:(559)]30.9413 <br /> Tel:(805)659-0910 Td(2N)942-0181 Mobile:(559)131-2399 <br />