Laserfiche WebLink
M M M M M M M M M M M M ✓♦ M M <br /> Rep o: I_?>rs i/A— MIM <br /> 0 Name A- '(_ RssCC\OLV S Project VIM6 _%L (,M& - <br /> N Address !ll? l-&ut.Palm Protect # 16393 .000 l3 m 5 E -¢ a <br /> C+ty d�,S u 8 Sampler Name ,q `— - -- -- - �,�3 � �, ~ <br /> LL State Zip q53� 1 /�1e,x �Iore.S ado y__, N o <br /> " W Q :3 Ec <br /> Z Attn �YevJ t A�� Q j, - -- - - ot�3 no z o <br /> � � U <br /> Q Phone'Zbg-5 9- ZZ2 Q--, 'C.sS- lq°t�OBI� �, b 333v�oM �. <br /> 0['33 <br /> _ Lab# Sample Description Date&TiMe Sampledl�- <br /> V M(01% 13 d ✓ ✓ Gly �0 "� <br /> ✓ V <br /> Cb a0 -✓ FV <br /> T <br /> 'PA I VA' <br /> r <br /> an <br /> w <br /> cm <br /> N <br /> '0 c' --5 VGS • tAW-3 - L40-S ' 11119'i OgZ(. <br /> �o x <br /> a <br /> t <br /> T <br /> 0 <br /> Urn <br /> w <br /> W r- <br /> w N <br /> a� <br /> 00 <br /> z 77 <br /> U 1 <br /> Billing Information: <br /> W <br /> Report Drinking Water Comments <br /> Q <br /> 0 NameSOW.L 6 on State Form'? Y /Y/ b VJ- Y_0 A OC. b4 EPl' 5 Mz o nay <br /> Send Co to / <br /> Address State of CalifY <br /> mCity State Zip RelUpishead by (5 ture} ce d by-(Sign tire <br /> Attention � ) [ Date Time <br /> Q <br /> Jelh uts d b i natu <br /> PQ # y g ) ( etc ived by (Signat re) -. Date Time <br /> ` Reiinqushed by (Signature) Received byF (Signature) Date Time ' <br /> 0 Time Mlles <br /> Fiat Relinquished by (Signature) Received by (Signature) Date Time <br /> Equipment Rate <br /> Revised 5/97 Sample Disposal by BC Labs may be billed at$5 001 sample for non-aqueous Samples <br />