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THE CHA�OF CUSTODYANALYSIS RAEST <br />r17/� ZoTWINING <br />L A B 0:R A T O R 1 F S , I N C . 2527 FRESNO STREET • FRESNO, CA 93721 • (559) 268-7021 FAX: (559) 268-0740 <br />r'IMITTER INFORMATION: <br />r._. -ORT - SEND <br />1 `ADDRESS: <br />ADDRESS• <br />� <br />INVOICE TO: <br />ADDRESS: <br />RESULTS RELEASED T0: <br />ATTENTION: <br />ATTENTION: <br />ATTENTION: <br />PH Gt 1 <br />FAX (boa > C( <br />PH ( PH <br />FAX ( FAX <br />CONTRACT # OR P.O. <br />BACTERIOLOGICAL SAMPLE SOURCE <br />SAMPLE STATUS <br />REPORTS FOR: <br />COUNTY: ❑ FRESNO ❑ KINGS ❑ MADERA ❑ MERCED ❑ TULARE <br />❑ STATE DEPT. OF HEALTH SERVICES LJ OTHER: <br />PROJECT: <br />SITE: <br />❑ PUBLIC SYSTEM <br />❑ ROUTINE <br />❑ PRIVATE WELL <br />❑ REPEAT <br />Ll SURFACE WATER <br />L1 OTHER <br />❑ CONSTRUCTION ❑ OTHER <br />SAMPLE INFORMATION: <br />PROJECT #: <br />SAMPLE BY (PRINT NAME)' Q' �a <br />PROJECT MANAGER: <br />U AN SIS <br />z <br />❑ RUSH ANALYSIS, RESULTS NEEDED BY: <br />DW <br />Y FOR CHEMICAL ANALYSIS SAMPLE TYPE <br />SL - Soil/Solid <br />Biosolids GW - Ground Water ST - Storm Water <br />- Drinking Water SF - Surface Water WW - Waste Water <br />ANALYSIS REQUESTED J <br />v <br />1' '� 2 <br />O Z <br />y <br />(LAB USE eorrces) <br />L <br />B <br />u <br />s <br />E <br />SAMPLE ID <br />vo <br />DATE <br />SAMPLE <br />TIME <br />TYPE <br />s • <br />110 <br />�0.0'!� <br />LJ LA) <br />c <br />COMMENTS: <br />p( <br />t SG tr %>" TC 4f Ole h+ l <br />�"111NQUISHED BY COMPANY DATE <br />i Z.- 6 <br />ITIME RECEIVED BY COMPANY <br />y3o <br />