Laserfiche WebLink
ENVIRONMENTALCHAIN OF CUSTODY , psA <br /> AND ANALYSIS REQUEST DOCUMENT 1 ORIGINAL <br /> i <br /> Rush Analysis: 5 Days 2 Days 24 hrs. <br /> Client: Fal si 1 4�VL� LO Subject to surcharge <br /> Customer Number: -��_ i� v QA/QC report required: yes no <br /> Sinck4lnn CA,Address: nh ��C}-7 � Electronic Data Transfer: yes no/ ,J ` ampler Set up Date: Time: If yes,To:State_ Client _ Other <br /> Phone: C 7 .�FAX. e T 66>3 Mileage: Lab number: <br /> ii ``'''� ❑ ❑ <br /> Project nm <br /> ae: '9C`C''TIWl 0Lab Loc: SP ❑ STK ❑ VI <br /> p �N'1r �-`F.m <br /> Contact person: �'1 k)-k-C.)r\ <br /> a <br /> Billing Information(if different from above) tx <br /> Name:~ n U <br /> Address: °G <br /> C7 ® Ns <br /> a x0 �O �� <br /> mm Q <br /> Phone: _ > o 0 ' Z C O <br /> FAX: U F o rn O 00 <br /> Q <br /> Contact person: N 3R o A UEn <br /> 4 Z A <br /> o <br /> Purchase order/contract/FGL quote number. <br /> (°; <br /> o <br /> U C7 0 0 W M L z <br /> Pre Log Required: yes no 6h �? Z d N a Z Z <br /> o °' 3 3 to a ti x <br /> SAMPLE INF0101ATION Sf"�CTIQN IV <br /> R a <br /> w u o �a2� f � t <br /> x .1 C4 <br /> Sample Location/Description Date Time e a 3 rn v N x e2 <br /> Number Sampled Sampled Z ov y�? m" <br /> ANALYSES PERFORMED IN STOC. <br /> WN <br /> -----ALL-OTHER ANALYSES A PAULA. <br /> 1 I I I <br /> W"CTION VI <br /> Reib d subj terms and conditions on the reverse of this document: <br /> spy r / A <br /> Date a®Gs^'7 7 Time 1�. Relinquished by:_� `+..-- Date Time <br /> �7 T / <br /> Received by (�u ry�/�pp Date 2"10�f J Time /� Q(...J Received by: �_ W. ca�r(f• f`�Tinre <br /> t��pP"Q HEV® d�+°ti��po: Y. S1ACRi�gR Date.2—'L -9j Time Relinquished by: Date Time <br /> LQEtVf 8•° GREYHOUND•°'OUN DateTime Received by: Date Time <br /> CORPORATE OFFICE&LABORATORY OFFICE&LABORATORY FIELD OFFICE <br /> P.O.Box 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 �y Mobile:(209)737-2399 <br /> FAX:(805)525-4172 FAX:(209)942-0423 FEB 19 1999 FAX(209)734-8435 <br />