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fitr-1 r�40r <br /> LABORATORIES/NG _ Date: �/ Page of <br /> 148 So.Vinewood Street, Escondido, CA 92029 (619)735-3208 FAX(619)735-2469 816 Church Street, San Francisco, CA 94114(415)920-9972 FAX (415)920-9983 <br /> Analysis Requested <br /> Client: &N✓O�_.-tt'/ C-CYZIA4 9 Turnaround Requested: <br /> ,�a <br /> / Onsite/24-48 firs. _ <br /> Site Address: � y1 <br /> ❑offsite <br /> �O e, <br /> ❑ Other. <br /> Project: <br /> Sampler(signature): <br /> Sample ID Date Time Location <br /> lam- <br /> S - S <br /> Da : • ; Date: ; Date: Sample Receipt Special Instructions <br /> �� <br /> Signature:' Signature:" Signature:* In Ch <br /> r <br /> Printed Nam Time: Printed Name: Time: Printed Name: Time: Yes NO <br /> Seal Intact: <br /> ComPa Company: Company: <br /> D te: � � ; Date: RECEIVED ; Dale: Yes No N/A <br /> /r Cold: <br /> • �IX,6 Signature:' Signature:' <br /> Signature: Yes No <br /> Time: printed Name: Time: Printed Name: Time: <br /> Printed e;� jA eceived on site <br /> Company: 4't(J' Company: Company: <br /> •Si nature mnstilules authorization to prcceed with analysis and acce tante of conditions 0n back. <br />