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E)b Laboratories, Inc. <br />Report To: <br />Client: <br />Attn: OLIJ Ul-11 I - na <br />Street Address: 4630 51 HwV 14- NOcrwl <br />1 — � — A[ — <br />A Name: Nf- Yt- <br />A Code; <br />jqCj, MO aampirrks); <br />URN State, Lt :Ji -Aaj2(4d%f <br />LzAA*Acj. wt <br />.. <br />;R. P1 <br />Phone:63,-934-qt1 i Fax: (,,3 (,- 39-- <br />t <br />A <br />Sam le Matrix Are there any tests with holding times less than <br />or equal to 48 h9ursl <br />Yes No <br />X41 <br />Email Address: bjd"*44 erj�ws" ivtas, J` <br />Submittal <br />> <br />w <br />* Standard Turnaround - 16 work days <br />48 <br />.=a <br />U5Z a165 Other Notes <br />.... ............. <br />X <br />DT - <br />T; I A IA'11, e well 2 1r 1530 <br />ITT <br />1 2. apkc-44 e It 1,70 532 <br />Pieta Bleink -Inlvoc Fnfcet it <br />Injer Fauce tt M 10 H0013 <br />lailo6r F,,,zet Q, '(At IL 1 1K X <br />7r-jg2 l k X <br />DIST— <br />F-1 Same as aboveReport Drinking Sample Disposal Special Reporting <br />Waters on State Form? FIReturn to Client Disposal by lab ❑Archiw: Oc E] WlP [] Raw Data <br />Client: E]Yes No I inq I sed ��y Date Ti dB Date Time <br />1)11?lld-7 Time <br />6 y 441U . <br />Hq,� It <br />CH S. A-t-tst"It, <br />q RA 1 <br />Address: <br />tate LA— Zip 9S33 Send Copy to State of 2. Zinqgshcd Iry Dake Time 2. Received BY Jun Time <br />-M.., &A, State)I <br />City. CA, <br />b,2 3. Received By Date Time <br />Attn&kr�Wrla ar ia Yes 0 No 3. Relinquished By Pale Time <br />PO#: <br />BC Laboratories, Inc. - 4100 Atlas Ct. - Bakersfield, C4 93308 - 661.327.4911- Fax. 661.327.1918 - www.bcla#s.com <br />M M M M M M M M M M M M M M M M M M M <br />