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K�Iv j�HM ANMLYSNWUEMCU2W M <br /> STa,� S r` Rush Analysis 5 Days 2 Days 24 hrs <br /> Client — I,/!�, /� �4C �� �`[�E- Sampler(s) �� '7 < Subject to Surcharge <br /> / Customer Number 3 —�� QA/QC report required yes no <br /> Address ` �71� Electronic Data Transfer yes no <br /> �z _ Comp Sampler Set up Date Time <br /> j — �� r If yes,To State Client Other <br /> �/ l—' <br /> Phone Time �� Mileage L.ab number (,_ <br /> FAX L.ab Loc SP ❑ STK ❑ VI ❑ ❑ <br /> Projeet name <br /> Contact person '� ^ <br /> Billing Informauon(if different from above) $ <br /> g1trne x <br /> Address <br /> u <br /> 3S > 3 O � <br /> Os ; <br /> Phone <br /> FAX <br /> Contact person y g 3^3 JF a <br /> o � Ee rn a u <br /> Purchase orderlcontract/FGL quote number <br /> o b E 05 z f Z <br /> Pre Log Required. yes no [7 z n 0 Z Z G �( o <br /> J q�q aq 343J a ;. h ✓ O .,u <br /> i $ r+2 <br /> o _ <br /> Sample Locauon/Description Date Time E <br /> Number Sampled Sampled Z <br /> 7�, F� C '+1 6 y j Z Z �- ,r 1 C , t C r rt <br /> cs 1 S F <br /> vim, z ra S <br /> wQ/ yrs L 12 3 a- .7. <br /> 7L,1,nqu,,b" >�to(fie terms and toodiueoe on the raretme of W r document. <br /> y'� } Dai��I�p Time L�f `� Reh Date TIM <br /> ` XJ <br /> 77 <br /> t5.ie I 6 Tune/ 112 keaived br Due DueTime Reluqu bl DotsTime <br /> Dem Time Rota; 'Dme <br /> CORPORATE OMCEAIABORATt7RY OFFICEa BORATORY FIELD OFFICE <br /> PO Baa 27712 53 Cntparuiaa Stmt 2500 Suaew¢h Road Viulm Ca;forma <br /> SnwPwliiCA 930614272 Stockton CA 95215 Tel 410937749173 <br /> Tel.(905)659 0110 Tel(2091 942 0181 Mobile(209)737 2799 <br /> FAX (905)5254172 FAX(259)942-0423 FAX(209)734-8435 <br />