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CALIFORNIA WATER LABS + P.O. BOX 4249 a 1430 Carpenter Lane + Modesto CA 95352 + (209) 521-4050 <br /> nate: ,d • R D E R F O R W • K Brderf ilo-454,� <br /> as <br /> Time: _-'-� P■ By: ---- ---------- <br /> CLIENT ] <br /> Contact Or <br /> Client s � �(j17 ���_1 Mpne: (—_____) �(( _ Representative: _ _fix <br /> -- -- <br /> ((��;� State: �(', Zip: ll_�--------- <br /> Address: --- ---------- City: --- --------- "`r <br /> BILLIN61 <br /> Purchase Order <br /> Bill To: }Z rI��C 1 Yi. Phone: L(�IL_�— Or Contract No.: ----------— <br /> Address: _1_11! - S1X �-- ---- City: -------- State: Zip: —11--------- <br /> Payment: Cash f........ .- Check f---- —- 1x+ Bill 1 Other: ----—------—------------------—-----— <br /> q C j � SA(MPLE LOCATION,, / PR0JECTI <br /> Address: QLL � 2LL <br /> UtJ----- City: �C! Y /n------- State: l 6�zip: ---------------------- <br /> ED <br /> Cross <br /> Street: _____________ 0.6. Tank Removals: Number __�____ Size, -0- Gals Type _, -------- <br /> Copy To: _ Qn—�O C Hyl�Z______ NOTE: Attach Any Special Instructions Or Diagrams As Necessary. <br /> 9 C H E D U L I N 6 1 <br /> Sample: l7-�,One Time Only I . Weekly —1 Monthly . I ouarterly I . Other: _______________ Start Date: _/ Ul: l <br /> AIA <br /> Results: u Routine 1I Silver Rush ' ' Gold Rush // 60 <br /> r Time: 10 Workdays 5 Workdays _ _ _ _ 2 Workdays -------------------------------- <br /> Y <br /> i Rate: @ List Price A 1.5 x List (Needs Lab Director's Approval) 0 2 x List (Needs Lab Director's Approval) <br /> Client Contact/Verbal Results: ------------------------------------ Date: --------------------------- Time: -------------- <br /> Lab I.D. # Test Code Test Description/Method Comments List Price Discount Costs Incurred <br /> V70 -30 <br /> s / ' s s <br /> r 36 C Q s �J cc, Z f <br /> s s s <br /> f Z f <br /> f Z f <br /> s s s <br /> Digestion, Extraction, Filtration, Or Any Other Special Handling Per Sample f S f <br /> Field Service Charges f 7 C <br /> Total Other Charges f <br /> TOTAL JOB COST <br /> File: OFWP6I.FRM Page I of 2 Rev: 05/04/1969 <br />