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-7El` 7.RG'�:" 1 -,, ,,A T-7 f,` "^ r-7 ' r-7 C:A"--'N [ '+�.,t,�'•"�•_�'Ua' -� �—•��t ; ,h �"` �-. <br /> U AND ANALYSIS REQUEST DOCUMENT V _J ORIGINAL <br /> REPORT INFORMATION SECTION III <br /> y <br /> Client: Rush Analysis: 5 Days 2 Days 24 hrs. <br /> Sampler(s): ^�� Y��LJs Z Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> Address: �� �d Electronic Data Transfer: yes no <br /> Comp Sampler Setup Date: Time: If yes,To:State_ Client Other <br /> Phone: <br /> 9 Time: Mileage: Lab number: <br /> FAX: <br /> Lab Loc: SP ❑ STK ❑ VI [� a <br /> Project name: <br /> Contact person: /!/��► � ��J'� 2 <br /> � a <br /> Billing Information(if different from above) <br /> v v <br /> U a, <br /> Name: � � � g13 <br /> Address: <br /> Is <br /> ' <br /> Phone' <br /> FAX <br /> Contact person: , 0 + z U <br /> 8 U k <br /> Purchase order/contract/FGL quote number: o tj v x F± W o <br /> Pre Log Required: yes no : eo E z h h .2 v z Z <br /> o <br /> Z V <br /> U c u .air as v' ti .�.. r/] ❑ Q] y <br /> r r ' 90 C'Jgo ILE �. .o v Q rn ..� rW Il: LZ <br /> y U I rn' U 3 'o A R O <br /> O A Q <br /> Sample Location/Description Date Time <br /> Ned Sampled z °" t`? -S. oz m cC f- U <br /> �/ � d �Z •?' %dao <br /> 010 <br /> 0 — /U <br /> IT <br /> 7Rbyp"Llbfe to a to and conditions on the reverse of this document: <br /> Date 74 Ti y'••�"'� Relinqu'sshed y Date Time <br /> � ,me b-- -' - _ - Dme- C - Ti V- Rxeivcd by: Date Time <br /> D BY: Y. JTA Date 1} Time Relinquishedby: Date TimeGREYHOUND -31-l'V_ Time Rxeived by: Date lime <br /> CORPORATE OFFICE&LABORATORY OFFICE&LABORATORY FIELD OFFICE - <br /> PO.Box 272853 Corporation Stmt 2500 Stagecoach Road , Visalia,California <br /> Santa Paula,CA 93061-0272: - Stockton,CA 95215 Tel:(209)734-9473 <br /> Tcl:(805)659-0910 - Tel:(209)942-0181 Mobile:(209)737-2799 ' <br /> FAX:(805)525-4172 FAX:(209)942-0423 FAX(209)734-8435 <br />