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ENVIRONMENTAL CHAIN U1" GU51JW ORIGINAL <br /> AND ANALYSIS REQUEST DO 5H <br /> ^-� ` Rush Analysis: 5 Days 2 Days 24 hrs. <br /> Client: E It y W cl x-J ,a C_ C '7 Sampler(s); J� "� Ct ova Subject to surcharge <br /> Customer Number: &` 0�V_ QA/QC report required: yes no <br /> Address: <br /> p Electronic Data Transfer. yes no <br /> Comp Sampler Set up Date: -`1 Time: f <br /> Phone: 1/4 f lit IRZ If yes,To:State Client Other <br /> FAX AM 6__ Time: Mileage: Lab number: 1 ) <br /> Project name: b —Q.y Lab Loc: SP ❑ STK Q VI d <br /> Contact person: C _ <br /> Billing Information(if different from above) t <br /> xName: � <br /> Address: a <br /> r. Q <br /> O a0 Obe <br /> O <br /> z � o <br /> Phone: C7 m <br /> FAX: f j o�S P d ti <br /> Contact person: In <br /> y 2 y a x a U <br /> Purchase order/contract/FGL quote number: ® 7 >? I <br /> Pre Log Required: yes no 6h Z H <br /> x lit <br /> Sample Location/Description Date Time <br /> Number Sam led Sampled <br /> AALYES FEW 10 <br /> di7W LYS�.TM MWIN <br /> gA <br /> Ra by subject to con ons on the reverse of this document: <br /> r t <br /> Date �} Time Relinquished by: Date lime <br /> a Date��G �lime �b+,m7 Received by: Date i/-O ` TimeA law, <br /> i <br /> Date! Time Relinquished by: Date lime <br /> Received by: Date Time Received by: Data Time <br /> CORPORATE OFFICE&LABORATORY OFFICE&LA TORMLDOWE <br /> P.O.Rox 2721853 Corporation Street 2500 Stagecoach Road Visalia,California <br /> Santa Paula,CA 93061-0272 Stockton,CA 95215 - Tel:(209)734-9473 <br /> Tel:(805)659-0910 Tel:(209)942-0181 Mobile:(209)737-2399 <br /> FAX:(805)525.4172 FAX:(209)942-0423 FEB ® 8 1999 FAX(209)734-8435 <br />