Laserfiche WebLink
El` iRCi ii�IE ALS rr.,. r- <br /> AND ANALYSIS REQUEST DOCUMENT -� QR€O)INAL <br /> / r r a <br /> Client: y�J �+ v' Rush Analysis: 5 Days 2 Days 24 hrs. <br /> - 7 f Sampler(s): Tom+ Subject to surcharge <br /> Customer Number: ,��/U 1 g <br /> QA/QC report required: yes no <br /> Address: _ �� Electronic Data Transfer: yes no <br /> Comp Sampler Set up Date: Time: <br /> / If yes,To:State_ Client rOther <br /> Phone: ' Sb Z !�S/'— Z�13 �7 <br /> Time: . Mileage: Lab number <br /> FAX: Z 1461 <br /> Project name: <br /> GfJr W fl �td Lab Loc: SP ❑ STK ❑ VI ❑ ❑ <br /> Contact person: <br /> Billing Information(if different from above) <br /> Name: �� c x �� <br /> Address: <br /> o o �� x <br /> Phone <br /> o c R f <br /> FAX: €� ' '�' rn° o E' ci eq <br /> w U N <br /> Contact person: o a 3 3 U N Z <br /> ,+ <br /> Purchase arderlcontract/FGL quote number: o o <br /> Pre Log Required: yes no d c 4P f Z <br /> uVVV <br /> p.:' -4) e. 5 .:T.'...C. E,;, ..? ..e.. ,.- .may 0., .-0 v <br /> Sample <br /> Location/Description Date Time <br /> Number Sampled Sampled Fy Z 0. 0 3 A ti Fes' U <br /> '-! ' / <br /> r <br /> CUSTODY SKTION V1 <br /> Reli .hed b r td s Iec the and conditions on the reverse of this document: <br /> �7 y^ I� <br /> Date L`! Time 1' -4.a-- Relinquished by: � _ Date Time <br /> -In <br /> Date c7"'Z' 1} Time��J ' -.- Received by: Date ���- j... Titne <br /> S v � BY: Y. STARR <br /> r4 <br /> �H-LJ�Jy �yy�� Dalr — - --rs Time Relinquished by: Date Time <br /> UKtTReceived by: "— Date3• —1 lJ Time Received by: Date Time <br /> CORPORATE OFFICE&LABORATORY - - OFFICE&LABORATORY FIELD OFFICE <br /> .'P.O.Box 272853 Corporation Street 2500 Stagecoach Road. Visalia California ' <br /> Santa Pauli.CA 93061-0272 -. Stockton,CA 95215_ - "t("?r,_1�, Tel:(209)734-9473 <br /> Tel:(905)659-0910 TO:(209)942.01R1 �.1 Mobi lc:(209)737-2399 <br /> FAX:(805)52523 4172 FAX:(2091.942-04 ,,, I 1 - " <br /> - FAX(209)734-9435 _ <br />