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LABORATORY .� (� 0 HAIN OF CUSTOP <br /> CAST ANALYTICAL � � .�� <br /> Location: 2333 Shuttle Drive, Bldg 908/909, Atwater, CA 95301 Certi icate No. 2078 J <br /> Mailing Address: 2333 Shuttle Drive, Atwater, CA 95301 PAGE ( OF� <br /> Phone: (209) 384-2930 - Fqx: (209) 384-1507 i <br /> Customer: "J4h(,CA REQUESTED ANALYSES ethod of Shipment: . L <br /> Address: I LJL V — W i/n� (1Yzl T <br /> City/State/ZIP: C r' a v, Notes- <br /> -W <br /> otes:w <br /> Phone / FAX: '1 00(60 Zuq 46.1" 111 W ro � � W N m o <br /> Pro # °- y a W <br /> 5 �� r a eJ LL <br /> o a W <br /> Report Attention: P r W <br /> Sampler Signature: a S <br /> Printed: " y n z <br /> VA.gFRVATinN.;/RFMAAV R <br /> 4eb tD1� SAMPLE ID DATE TIME DESCRIPTIONILOCATION <br /> 2-r-vojolt; s 30783 <br /> $0784 <br /> 3� D <br /> 30785 <br /> i <br /> ubmitted l <br /> Printed Name Date Time <br /> Company Name Inumbethe laboratory� <br /> ,.. � Tata o <br /> Note:All special requests(e.g.quick <br /> Relinquished by: ne w turn ti"s)must be cleared through <br /> Received by: •/!QI'! a -d authoHzed laboratory personnel. <br /> Relinquished by: <br /> Received by: <br /> RESULTS DUE: <br /> nu <br /> Relinquished b <br /> q Y <br /> .— VERBAL C WRITTEN <br /> Received by: N 11110 AR <br /> HEAD SPACE ABSENTrr ►ati��c � �. <br /> i <br />