Laserfiche WebLink
CHAIN OF CUSTODY <br /> n V I RO I`I M El`ITAL AND ANALYSIS REQUEST DOCUMENT <br /> COPY 2 <br /> SAINI/I� ' ' / ' ! <br /> Client �Ph / Rush Analysis 5 Days 2 Days 24 hrs <br /> Sampler(s) _�w(/. r� Subject to surcharge <br /> Customer Number - <br /> G,Y��� � QA/QC report required yes no <br /> Address tyri /- I ` <br /> / - _ _ ElectromcData Transfer yes no <br /> r :(�TJVJ 9 5 cZ�_ _ ___ Comp Sampler Set up Date Time <br /> r�U1 1 -7-7— <br /> 7 N 7 f If yes,To State_ Client __,_ Other <br /> Phone I �I <br /> Time Mileage Lab number <br /> FAX <br /> Project name , / .� �.'ti7�-�` 'Ae?�7'TG1?S Lab Loc SP C) STK ❑ VI 13 ❑ <br /> Contact person S.ff vh//,I,- C" � +(r_ _11olrh K, <br /> 3 <br /> Billing Information(if different from above) - <br /> 0 <br /> Name y <br /> Address .. M <br /> d <br /> C7 O 3 t O 3 a p p <br /> 00 C � 0 3 -- R o <br /> z <br /> Phone a N y v 1„ > <br /> FAX a r° v' V7U �t�a v, Q x <br /> Contact person o F d n' GL + z F* 1 avc <br /> in <br /> Purchase order/contractiML quote number o e M W 85 <br /> Pre Log Required yes no z Y r z x d <br /> INFORMATION ; Y 3 `iy r�i a iN� v 1� <br /> SANIPLE W O O e t/] e: r vv <br /> t N <br /> Sample Loeation/Descnption Date Time $. p 3 3 Z <br /> Number Sampled Sampled 4 q GO ado C4 C� U <br /> I � v t►� ' I ��/� <br /> 14zo ,_L <br /> ' _G 1930 <br /> (� 0 <br /> CUSTODYREMARKS SECTION V <br /> -71 (1/119 I LET Reil shed b r terms d ditlons on the rtrerse of th nG <br /> `l 7 .c� r L Date Time Rdtngwdied h Time <br /> �')' R.M.eceived • r Date �`2 1 1 , `e/ Received by- D= Time <br /> Rdinquudipd by' Date�Time� Rehngtnahed by DaleTA Time _ <br /> OReceived by Date Time Received by Date Ti <br /> CORPORATE OFFICE&LABORATORY OFFICE&LABORATORY <br /> FIELD OFFICE <br /> PO Box 272/853 Corporation Strom 2500 Slagecoach Rood Visalia.Cal,tuma <br /> Santa Paula CA 93061-0272 Stockton CA 95215 Tel (209)734 9473 <br /> Tel(805)659 0910 Tel(2091942 M 81 Mobile(209)737 2399 <br /> FAX (?4)5)521 4172 FAX r'no}oa,at,i Ge V r'nn —,a 1-ic <br />