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Er� <br /> V tR l iAE '1 [AL AND ANALYSIS REQUEST DOCUMENT I ��� ORIGINAL <br /> r r <br /> ��/ Rush Analysis: 5 Days 2 Days 2g hrs. <br /> Client: FComp <br /> (s}: C//i��Y <br /> Subject to surcharge <br /> Customer Number: <br /> �aD � ��� �� QAIQC report required: yes no <br /> Address: S -- Electronic Data Transfer: yes no <br /> mpler Set up Date: Time: If yes,To:State Client _Other <br /> Phone: �L /� )f �l�FAX: z� � Mileage: Lab number: +�" �3 <br /> .... <br /> Project name: <br /> OgTl�- j- AI4,7- Lab Loc: SP ❑ STK ❑ VI ❑ ❑ <br /> Contact person: <br /> Billing Information(if different from above) <br /> 6 � � <br /> Name: <br /> o nr ea <br /> Address: <br /> o. hu.c O my 3 p• O � <br /> Phone" w N '✓ 'In 1 <br /> e a c <br /> FAX: . <br /> C <br /> Contact person: $ i R m 3 Q U s 4 z w \v "C1 <br /> o Ufa o, + F. v' aGi <br /> Purchase orderlcontract/FGL quote number. o E�7 v o°Jo E x �n <br /> _ O 45 <br /> Pre Log Required: yes no ,�.• c7 z y a Z °z Q a <br /> Q <br /> 75 <br /> O p O 'O rl �+ N <br /> Time <br /> +� '� b� <br /> Sample Location/Description ' Date me ° <br /> Number Sampledd Sampled ' °' y <br /> z 9 Z✓� P - <br /> 17 <br /> REMARKS CUSTODY SI:C'[']()N V1 <br /> Reh ed by d su>tn to the ems and condiums on the reverse or this document: <br /> Datg2 g4 Time / Relinquished by: 7' - i Date Time <br /> Received by:• r - Datell Time J ''30 Received by. ��"'Z/ Date <br /> .. �11 il1'it=�NY: V. M11H <br /> i9g Date 15 Time Relinquished by- Date Time <br /> Recdved by: Date j rout Received by: Date Time <br /> CORPORATE OFFICE&LABORATORY OFFICE&LABORATORY - FIELD OFFICE ' <br /> .PO.Box 2721853 Corporation Street 2500 Stageroach Road Visalia.California - <br /> Santa Paula,CA 93061-0272 - - Stockton,CA 95215 Tel;lia.C 73llmia <br /> TeL(805)659-0910 Tet:4209)942.0181 Mobile:(209)737.2399 <br /> FAX:(805)525-4172 FAX:(209)942-0421 FAX 009l734-9435 <br />