Laserfiche WebLink
TT .4 TXT / T­ / T TCTrr '%Tl TT <br /> 2 www.rgiinc.com - <br /> IN/).IA,IL)NlS'ItFUl.l"ST DOCUMI':\-1" <br /> CLIENT DETAILS S E CTI 0 N 1 6WU 1 U N <br /> Client: Sampler(s): Rush Analysis(surcharge will apply): <br /> ❑ New Customer Customer Number: - /�r� 05 Day 04 Day 03 Day ❑2 Day ❑24 hour <br /> Address: ll.• Rush pre-approved by lab: <br /> Comp Sampler Set up Date: Time: Electronic Data Transfer:IJ yes []no <br /> Phone: Fax: Time: Mileage: If yes,To:State Client Other <br /> E-Mail: Shipping Charge: Pickup Charge: Lab number: <br /> Project name: <br /> Contact person: <br /> rr, <br /> Billing Information(if different from above) a o <br /> 0 <br /> Name: <br /> Address: o a g 3 o a o s Cz <br /> oEC3 <br /> Phone: Fax: " a <br /> E-Mail: o O <br /> a ll7 a o + m <br /> Contact person: o G = er o °' = CO <br /> Purchase order/contract/FGL quote number: c w z° A i LJ w = a Z z a — <br /> Monthlyl7 Weeklyo Quarterlyo e M a m >. a+ ) <br /> Pre Log Required:yes_ Frequency: Otherci v76 <br /> SAMPLE aa aL9= ?o M <br /> INFORMATION ( Emo0Date Time aSample Location/Description Sample . a (Number l <br /> = iZ <br /> 'n m m o: -~' C41? Q <br /> /2L ( a l P Gw <br /> 114 010 F&I 14 <br /> 1 CUSTODY SECTION <br /> H,yri.hc I b a :`yycr:m tlm trrm+end cnnAilinn+an ih -,rr c of Ilii.tlrtnmr n <br /> INI U Dmr: Tlmr: uelmgvlahta bp: mtm rm:e: <br /> ilre9.'ed by: Dn4: Timer areeb'ml Lr: Dnlm Time: <br /> 1101 lW00 by: Due: Time: arl1..,hhed by: Dvly: 'nmr. <br /> Ihvd+'ed he: naa: Time: arceb-ed by: Oele: Tinm: <br /> Corporate Offices&Laboratory Office&Laboratory Office&Laboratory Office 8 Laboratory Office IS Laboratory <br /> 853 Corporation Street 2500 Stagecoach Road 563 East Undo Avenue 3442 Empresa Drive.Suite D 9415 W.Goshen Avenue <br /> Santa Paula.CA 93060 Stockton.CA 95215 Chico.CA 95926 San Luis Obispo.CA 93401 Visalia,CA 93291 <br /> TEL:(805)392-2000 TEL:(209)942-0182 TEL:(530)343-5818 TEL:(805)783-2940 TEL:(559)734.9473 <br /> FAX:(805)52541172 FAX:(209)942-0423 FAX:(530)343-3807 FAX:(805)783-2912 FAX:(559)734-8435 <br />