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mom. on un .n ... .,... . ... .... .... ...v , ....... .a a •wuc a.v en N+a. •.. .. .... <br /> Date: — "r rr `1—� '� R 0 E R F O R W 0` K OrderAi <br /> 74 I hr - - <br /> Tiie• �L: �_ pm J � BY: 2 -L�SCsF�_ <br /> C L I E 9 T I <br /> II <br /> Contact Or <br /> - II <br /> Client, _'��?_�t _: :(L_ LPhone: (?C_�j ) %LI�- 1'1�`l Representative: --____-_----___— <br /> Address: t 1 ---1 I�---------------- City: ---------------------------- State: ---- "p' --------- <br /> 31LLIN61 <br /> -- Purchase Order <br /> Bill To: L'c'4� ::1 ` 4 i _ —_ Phone: (2 r ) SY5 - (.'1 2L( Or Contract No.: <br /> Address: -- �5 rl� :<i: 11 c {p City: _-_ Ty_ ._=r ---_-_-- ---- State: Zip: <br /> '---------------� -----"'----- <br /> Payment: ; ) Cash 1 1 Check f . ;74' Bill 1l Other: ----—_�_--___—_____u—M—_—� <br /> SAMPLE LOCATION / PR0JECTI <br /> Address: CU !a�P ,Sils��---____---- City: IVic_, cy T tiss_L State: « Zip: <br /> Cross <br /> Street -------- U.S. Tank Removals: Number ?_ Size L Gals Type _Chu - <br /> Copy To: NOTE: Attach Any Special Instructions Or Diagrams As Necessary. <br /> S C H E D U L I A 6 1 <br /> Sample: ^x One Time Only 1-1 Weekly Monthly 1 Duarterly Other: _--___— _ _ Start Date: <br /> i <br /> Results: l4q--, Routine 1 Silver Rush _) Gold Rush <br /> e Time: 11 Workdays 5 Workdays _________________________________ 2 Workdays ------------—_ <br /> e Rate: I List Price 11.5 z List (Needs Lab Director's Approval) ! 2 x List (Needs Lab Director's Approval) <br /> Lab I.D. i Test Code Test Description/Method Comments List Price Discount Costs Incurred <br /> i <br /> nn FAIR <br /> ! Z f <br /> f Z s <br /> f Z s <br /> Digestion, Extraction, Filtration, Or Any Other Special Handling Per Sample f Z f <br /> Field Service Charges s <br /> Total Other Charges $ <br /> TOTAL 108 COST <br /> File: OFWSI.FRN Page 1 01 Z Rev: 01/31/1989 <br />