Laserfiche WebLink
Ank <br /> CHAIN OF CUSTODY <br /> www.fglinc.com AND ANALYSIS REQUEST DOCUMENT ORIGINAL <br /> Client: C+ Sampler(s): Rush Analysis(surcharge will apply): <br /> O New Customer Customer Number: ,1���n 05 Day 04 Day 03 Day 02 Day 1124 hour <br /> Address: 2067 y Nw %4o 1 Rush pre-approved by lab: <br /> Comp Sampler Set up Date: Time: Electronic Data Transfer:Ayes ❑no <br /> Phone: d0�•5�- $34a Fax: Time: Mileage: If yes,To:State Client Other <br /> E-Mail: Shipping Charge: Pickup Charge: Lab number. 203A6o3 <br /> Project name: fl'&GP <br /> Contact person: U <br /> Billing Information(if different from above) a _ o <br /> Name: p �rtw\ yc. 0 _ 0 3 o <br /> Address: o,a A o 3 o a o C <br /> c v E c 3 0 (10 z 0 <br /> a p to rn o a V C <br /> U w m C � <br /> Phone: Fax: a v t° o w <br /> Ne A _ v 0)) o c In F <br /> E-Mail: 0 F= 0 cc a N to w <br /> 0 3 3 v m a + z <br /> Contact person: o G = a o a v = a <br /> ~ = v E S � O - a 7 <br /> Purchase order/contract/FGL quote number: o, a ki ° a, O a z o <br /> Monthly[] Weeklyo Quarterlyu c E ;6r za 3 a, -- z <br /> Pre Log Required:yes Frequency: othero E v ? w N N a <br /> M pO kA 1° .� <br /> o op o Ind 0 J v d <br /> Sample Location/Description Date Time a o.> n to T s Z O <br /> Number Sampled Sar pled 1-T z g? a c3 Z m m m d a <br /> 4 -C ►q o <br /> Ll <br /> [tReceived <br /> bb d subject to the termsend coodltloes ee arccrse of this documents• � � ��,��ITlme: �...7D Retluquished by: Deteli�/' • Tlme: <br /> by: Dote [/ Ime: ��'��r111111......��iii�//////IIIrrrRettived by: Date: Time: <br /> hed by: CAK- Dote:�Tlmc:�Rellnqulshed by: Detc: Time: <br /> by: A71) Dote: Time:_Received by: Date: Time: <br /> Corporate Offices&Laboratory Office&Laboratory Office&Laboratory Office&Laboratory Office&Laboratory <br /> 853 Corporation Street 2500 Stagecoach Road 563 East Undo Avenue 3442 Empresa Drive,Suite D 9415 W.Goshen Avenue <br /> Santa Paula,CA 93060 Stockton,CA 95215 Chico,CA 95926 San Luis Obispo,CA 93401 Visalia,CA 93291 <br /> TEL:(805)392-2000 TEL:(209)942-0182 TEL:(530)343-5818 TEL:(805)783-2940 TEL:(559)734-9473 <br /> FAX:(805)525-4172 FAX:(209)942-0423 FAX:(530)343-3807 FAX:(805)783-2912 FAX:(559)734-8435 <br />