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ENVIRONMENTAL AND Ur c,'USTUUY ORIGINAL <br /> ,/ AND ANALYSIS REQUEST DOCUMENT <br /> Client: kAL. L F 7 `���.S T���� Rush Analysis(subject to surcharge): <br /> Sampler cg): �Q037Tim: <br /> ❑ 5 Day ❑ 4 Day ❑ 3 Day <br /> ONew Customer Customer Number: (3�/U e <br /> REEW11S ❑ 2 Da ❑ 24 hour <br /> Z1712Address: l3 /.3 S- STOC�'TONST. Y1f�yy A-�j p6-oZZ. GComp Sampler Set up Dale: Electronic Data Transfer: yes no <br /> Phone' o 0) 36O — O 6 O / <br /> FAX: RO 9 3G9- 9nGTS Time: Mileage: LabiiIf mber:State C' nt outer <br /> Project name: El-1D 11V5 ee-71aV 5"AAMIeS Lab number: <br /> contact person: A2/=D 48,4,g/m BACrI' F12 <br /> Billing Information(if different from above)ne:Address: ;,_3 Phone: mFAX: ° co= ❑Contactperson: Fi��iJ �ifJ�/�7/�/4 .,3 q u r� '\ (Q 'lr �'U 0 <br /> Purchase order/contract/FGL quote number: A�� 7 J,37y pPre Log Required: yes nom z d3 ALl <br /> z Eu A X <br /> rSample Lucation/Description Date Time 4i y 3 H `° .�"a �' a a y <br /> Sampled Sampled Z tT a W to <br /> F U <br /> As 2 FLOOR- S X111_= � a 2.#M G 1 � <br /> PA/MT ASN 2 3' Cr I G X XN/A/E O/� dOR S/af=E/� Z a a le G l a X!lFELA&MMR- /A!P_$ 3 /T 6,soG l a X CAKED ATac -SceAP AIN sou�,v 3 0Soq Le CT ► G X X <br /> C <br /> A <br /> a <br /> m <br /> 0 <br /> f- <br /> adm - ed 61 a m a110 1ne 1em�.v1 coaai oa 1ne r<.aM onni:documem: <br /> r <br /> S <br /> Ds,.a�/ �� IinquivbW bY: `' DRc 1mC <br /> 4 2M <br /> Rcccivcd nY' f C L' ,j_ Unc J/�Tme kif ReQb,Rdinq,i hese" C 1 am J , 0AIT,me 0: C) Time <br /> rD <br /> F 71 <br /> CORPORATE OFFICE a LABORATORY OFFICE 6 IABORATOIIY _ FIKWOFFICE 0 <br /> P.O.Boa 222Yg5]Cwporalion 51rte1 25005ugCA 95 15 Visaliv,C+liromia / / <br /> Santa Faala,CA9RKl-0212 Smetlm.CA 95315 TeL(2m))10.91]l ''IV/Y^/ '/Vl <br /> TeL(M)MM io Te1:(2n9)9Q-0181 Min,k12091232�23. <br /> FAX:(M)5254172 FAX:(2n9)%2­0g23 FAX(2m)1]4.8413 <br />