Laserfiche WebLink
CHAIN OF cuss ECOR <br /> APPL, Inc. Phone: (559) 275 2175 <br /> 4203 W. Swift <br /> Fresno, CA 93722 Fax: (559) 275-4422 o.o.c. N° 16429 <br /> Report to: PLEASEPRINT Invoice to: PLEASE PRINT <br /> Company Name Cf(s2_ l� '� <br /> ! Phone:��� v2:$'�' ? Company Name _ r���/� Phone: <br /> Address S fS GT a' / I'lA ) 5-t,i� /am Address <br /> too,4A'1.oi 1 (;47 ie IC7 nFax 4-,2. _2�oSgl Fax: <br /> Attn: l�'`� �a.� "I" Attn: <br /> tnect Nam des, Sampler(Print) Analysis Requested/Method Number Date Shipped: <br /> a, -;- - 4 �a01- �leo Carrier: <br /> Purchase Order Number Sampler gnature) Waybill No.: <br /> Comments: <br /> f <br /> Sample ident4ication Location Date Time Matrix Numberot <br /> cdwacted Collected conta ners n� <br /> •//S/v- S.f7� rn iOl 9!� a {h GL/o Pll oY s <br /> - w-/1SA1- s` �= t Itsd u K = <br /> ez <br /> l <br /> Shuttle Temperature: Turnaround Requested: MUST CHECK ONE Sample Disposal: <br /> ❑ Standard(2-3 week) ❑ One week 48 hour ❑ Return to client ❑ Disposal by Lab i3o,-� ) <br /> Relinquished by sampler: Date Time Received by: Relinquished by: Date Time Receive by: <br /> 26Z AW- <br /> Relinquished by: Date Time Received by: Relinquished by: Date Tme Received lab by: <br /> White:Return to client with report Yellow:Laboratory Copy Pink:Sampler <br />