Laserfiche WebLink
i.r THE O <br /> 2527 FRESNO STREET <br /> ORD6601 # n �a ,MNING', ,oP,E FRESNO, CA 93721 <br /> �. {209) 268-7021 FAX:(209) 268-0740 <br /> ;HA1N OF CUSTODY/ANALYSIS REQUEST <br /> INVOICE TO:(OTHER THAN CLIENT( COPY REPORT (Circle One) <br /> REPORT TO: / n _ <br /> ATTENTION: C U�'� {�(j'iQ v ATTENTION: wl ,/n i .-I r State Dept.of Health (DOHS( <br /> t <br /> E:SdCk o•. viNAME: Fresno Madera Mariposa <br /> RESS: �� ADDRESS: Tulare Kings Merced Kern <br /> OTHER: <br /> FAX: ` CONTRACT!PO # <br /> BACTERIOLOGICAL SAMPLES ONLY PROJECT INFO: <br /> COMMENTS 7�7c/ <br /> PUBLIC ROUTINE ? ( /C' ►(0 <br /> IGS SURFACE WATER REPEAT <br /> S CONSTRUCTION REPLACEMENT PRJ#: L S 0. <br /> OTHER OTHER MGR: ik- TO V440 <br /> i� PRIVATE ANALYSIS REQUESTED <br /> TURNAROUND REQUESTED: Icirde one) <br /> I� ��ROUTINE RU Specify Date}: , <br /> �i SAMPLED BY (PRINT NAME): /r(-125f t-- <br /> SIGNATURE: <br /> TYPE KEY Driiifcing Water bW VJ>lste Water VJ1N Aqueous AQ <br /> SolidlSoil SL Otfier Q.IDescribe in Comments) �u+ <br /> y' <br /> IDR SAMPLE ID SAMPLED TYPE C/ <br /> DATE TIME <br /> 1663 <br /> I <br /> X <br /> X -. <br /> N X X r <br /> SS -� 130 ; < <br /> IV 1qq <br /> RELINQUISHED BY COMPANY DATE "; TIME EtECE1VEQ pY <br /> GQMPANY <br /> FEE E- <br />