Laserfiche WebLink
CHAIN OF CUSTODY <br /> ENVIRONMENTAL AND ANALYSIS REQUEST DOCUMENT ORIGINAL <br /> 'J.'CLIENI' DETAILS SECTION I SAMPLING SECTION 11 REPOR <br /> ! � + <br /> C tient: D� r ySampler(s): N4 l 1 Rush Analysis(surcharge will apply): <br /> 1:15 Day ❑ 4 Day 1:13 Day <br /> ❑New Customer Customer Number: '- <br /> Address: P c)� f3OX 2(50 ❑ .2 Day. ❑ 24 hour <br /> Z Comp Sampler Set up Date: Time: Rush pre-approval by lab: <br /> inital <br /> Phone: Z'YA 3 —6(f 3 Time: Mileage: Electronic Data Transfer: yes no <br /> FAX: 7J O-7 Z3-- If yes,To:State_ lent O er <br /> Project name: <br /> 1?/w2 L Shipping Charge: Pickup Charge: Lab number: <br /> Contact person: .fby $ <br /> Billing Information(if different from above)' a <br /> " Name: <br /> F= a a <br /> 3 _ <br /> Address: y o rd <br /> C7 p 3 a p <br /> Phone: V _ o _ a <br /> FAX: w a a+ F A` J0, o c m W <br /> A cc <br /> Contact person: a o p Zj <br /> N a v i .� { <br /> -Purchase order/contract/FGL quote-number: x <br /> o v ao a W O r 3' <br /> Monthly ❑ Weekly ❑ Quanerly Q c V z 4�i F a z 0 w <br /> Pre Log Required: yes Frequency: Other❑ b to o a \ 1 <br /> o a 3 3 U" vt a y V to <br /> 1415 LIN 11 <br /> Wa T c <br /> WO i? m v <br /> V cid of0 $ — a y {NJ <br /> Sample i, Location/Description Date Time T El� if 3 3 F= X Z <br /> Number Sam led Sampled F- Z <br /> a 3i <br /> MPJ r_ T II(gZA Cg5-75 <br /> C <br /> A <br /> H <br /> z <br /> .. R7quished nd s jets to the terms and co n I e reverse orchis d FA A <br /> r� p,., <br /> D t Dae Tme <br /> Received by:7 - <br /> Date k - 1 �DiiJ4' 'wNbrie <br /> " { <br /> J Ipff UV <br /> Relinquished by: Date_ Date Time <br /> - Received by: Dale Dale - Time ' <br /> Y: <br /> CORPORATE OFFICE&LABORATORY OFFI( FIELD OFFICE <br /> 2500 S Visalia, )734-94 <br /> P.O.Box 272!853 Corporation Street Stockti� Fel:(559}734-9473 <br /> - Santa Paula,CA 93061-0272 Tei:(2 Mobile:(559)737-2399 <br /> Tel:(805)659-0910 FAX(559)734-8435 <br /> FAX:(805)525-4172 FAX:i <br />