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r _ - tr .,��.- �� 4 � r r r r r r r r r <br /> 0114! g THE WINING LAB RATORIES, INC. project Name ' r-°-" <br /> 2527 Fresno Street, Fresno, CA 93721 Address <br /> (209) 268-7021 <br /> ichai n-ol-Custody and Analysis Request Record Mgr. TLIf <br /> Date 'f / <br /> —�-— <br /> Page of Copies To: S� <br /> T '' <br /> Report To: Analysis Requested <br /> �/� �- �" 1 /-" . <br /> Client Naml WfC YI� urS ISA, ? !�'� Bill To: S y 'ta <br /> Addresses <br /> r <br /> G JM�L <br /> Contact Name xpected Turnaround: ^ <br /> Phone Z �z- ROUTINE D RUSH VERSALS' D RASH REPORT" <br /> Contract/PO# Additional Fees Apply v <br /> Sampler Name Specify Date: / <br /> (Print) FAX ff <br /> b Client Sam le Sample rt r As a <br /> 3 J bs a 1 <br /> -yy,, ! Sample ID Date/Time - Type �"�>M ` #/Sizt;(7ypeof Conti,ner;�std," Presenfatton/Handling myf Location <br /> 4 I ���" I y nr'�r <br /> yesL s �I;a r ly?�ro/'J r`((/ 1 i`tNA k', <br /> � <br /> �1 <br /> �T' tid� i e •x k e"k 1 };;. r -+•• t�'!-f.:. Thr n�Y <br /> 'b.,r��F t r r '` rM ti'y4�..t�k•�hs .� }>'�"kF\iii � � <br /> , 1 •- i�1:r r�, �Ir,� rf 'Fi i�Ir 7.,y' n .�c s� rrYr�,e�1�rys�e! x <br /> ' " • 47l1��`��Ft c' �f1•�'.dt� rtes , 1Ja '..;J_- r <br /> qq��1 t <br /> #5a{` t ."D"Fqki <br /> 't :r {�..iht� -s.r <br /> t�i•!_� K:Fw <br /> 1 <br /> s <br /> yuiY V 1-` •' -t 3C 4,. A�, "-!'.,A L t• 5�i r.1 S � :1 � I f 5': '� i <br /> •4'". !r; � �r<-.i Jr1 f° 'l xa '� ,. x t r,cF <br /> Each hazardous sample submitted For Water samples, please ' 2 y <br /> p Comments: Dept: If�lttlals � DatelTame <br /> loranalysis will be charged a hazard- check one of the following: <br /> K.'•r_ �, 6a�'+i" �3 '.s �Y.�nR raYn. r..� F 'c t,.?x r�.r <br /> ous waste disposal fee. Clients that D Drinking Water r :� t �, t}1•`; rg ,4, [ t�ar��t <br /> retrieve hazardous samples within 30C3 Waste Water .ir602 <br /> Z", <br /> t` days of the analytical report date will 0 Ground Wpter(wells) -SD .,. ,'.•.�� �.-•� '-r;' , 1 54"t4 ky <br /> be refunded any disposal fees. 1:13 rface Water(rivers,lakes) TV',r'�a,'r �,X;• Y�,f�m1a�,.' <br /> Relin uish B Delivered BY <br /> Signature <br /> ,�!�: ,"�'a a�f� �Rr•aJst ,r j1�-wiFl <br /> Signature c1GGJ���+✓✓/ " s <br /> L x F s q4t aft ` I tr�. M <br /> ` -- - - Ice— ;Signature a °'� �5lgnature <br /> 1f'inted Printed „CI-t,pr �^ =Com <br /> Cam an 1 4 1�3 H f R t til H 4 <br /> P Y �-•��---/� x Company ,}Date!`�'Iftle �w �. �f' `� x'��4� yDate/Ttme� Y'r cr. '. � <br /> . <br /> DatCTime " me ato/ii1xr y r' T,ime <br /> SHADED AREAS FOR OFFICE USE ONLY <br />