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CALIFORNIA WATER LABS } P.O.`' C 4249 f 1430 Carpenter Lane - Suite 6 + ModesV---A 95352 (209) 527-4050 <br /> Date: 0 R 0 E R F O R W O R K Orderf <br /> Tine: --' Pe By: ------ <br /> CLIENT ) <br /> cc -__ Contact Or <br /> Client: dt✓�C� __ Phone: ( )� -__9� Representative: <br /> Address: ----__yZL---1 ATS j ------------ City: ------ (G ESrc) ---------- State-(r _ Zip: ___I <br /> BILLIN67 TO 13 NU.M� <br /> Purchase Order <br /> Bill To: C_�_ ______________ Phone: ( ) -_j6e�___ Or Contract No.: <br /> Address: X31 ffi�T�j----- _ City: -----�D�ESS____------ State: Zip: __�S------------- <br /> Payment: : � Cash f ___ .__1 Check f----------- Credit Application Other., __ __________________ <br /> SAMPLE LOCATION1PR0jEr.. TI'.— �— <br /> 5� Zip: <br /> Address: _--��v---�'--L��.ZLs<I�L-- City: ---.---�l�Z ------- State: --------- " <br /> ------------- --------------------- <br /> Cross <br /> ------UNb itS <br /> Cross?";� <br /> Street: U.B. Tank Removals: Number Sized__ Gals Type <br /> County: 1� -_a&4 Qy LlJ__ _ NOTE: Attach Any Special Instructions Or Diagrams As Necessary. <br /> SCHE0ULIN61 <br /> : ;1; One Time Only 1 � Weekly Monthly Quarterly Other: ---—-------—_ Start Date: <br /> Results: 1_71"'Routine . 1 Silver Rush Gold Rush <br /> o Time: 10 Workdays 5 Workdays _ 2 Workdays ______,_._..__________ ____________ <br /> Y <br /> ----------------------- - ------- - <br /> 9 Rate: 4 List Price E 1.5 x List (Needs Lab Director's Approval) B 2 x List (Needs 1.4 Director's Approval) <br /> Lab I.D. i Test Code Test Descriptiontkthod Comments Qty List Price Discount Costs Incurred <br /> Pct <br /> 3-74 <br /> t — <br /> TP s m-p� <br /> U✓Sa <br /> s i s <br /> s z s <br /> f z s <br /> Digestion, Extraction, Filtration, Or Any Other Special Handling Per Sample f I S <br /> Field Service Charges s <br /> AA)I<77REn(pJ�1z- <br /> Total Other Charges s <br /> TOTAL JOB COST s <br /> Rev: 05/18/1988 <br /> File: INTAKEI.FRM Page 1 of 2 <br />