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+ MAIN OF CUSTODY <br /> 1NW W fgl int.CQ 1 .�..' AND ANALYSIS REQUEST DOCUMENT <br /> Client: St6ddon Rubber Lab Number- TEST DESCRIIMON AND ANALY QUESTED J <br /> Customer Number. 3011837 LLQI <br /> Address: P.O.Sox 639 t o <br /> Linden.CA 95236-0639 0 <br /> CV <br /> Phone: (209)887-1172 Fax: (209)867-0062 C <br /> £maa Address: fid(o.stod(tonrubber.com t:Y9 <br /> Contact Porsao: Ride Van Dusen UProject Name: (Q .. <br /> Purchase Order Number. £ Z <br /> Quote Number: ST20160916-01 <br /> Rush Analysis: [] 5 Day[:]4 Day❑3 Day❑2 Day E]24 hour m S ` 3 <br /> Rush pre-approval by lab(initak): ❑ a <br /> yS� a <br /> Electronic Data Transfer: D No State❑Client Other: <br /> Sampla(a): <br /> Sampling Fee: Pickup Fee: V <br /> o <br /> Compositor Setae Dare: Tone: _ tt <br /> Samp Location Description Date Tune <br /> Nrstt Sampled Sampled <br /> 1 sty T slam p#9- cl•21c 1(, ?:UQ C 1 G xI <br /> 2 -�t711S'MMt i s T �Z(a•t 7:oC7 C i G �X ��� <br /> 3l7 �AM �ts L, -24.,- i Ot7 C 1 G x ��� <br /> �I 1 I <br /> Remarks Relinquished Date: Time: Relinquished Date: Time: Relinquished Date. Time.. <br /> .-')A-M pits'# i 15 A 10-'h,noryM OAI'A C �Z� l3l i z <br /> Receiv fly: -1 Date: Time: Received By: Date: Time: Received By: Date: Time: <br /> Gorporibe Offloes&Laboralsry ORUS i Laboratory ORbo&Laboratory Office&Laboratory Offiw&Laboratory <br /> 853 Corporation Street 2508 Shoscoach(dead 683 E.undo Avenue 3442 Empresa Drive,Suite P 9415 W.Goshen Avenue <br /> Sante Paula,CA 93080 Sneddon,CA 85215 Chico,CA 95924 San Luis Obispo,CA 93401 Visalia,CA 93291 <br /> TEL:(805)392-2M TEL:(209)942-M82 TEL(530)343.5818 78:(805)783-2940 TES-:(559)734-9473 <br /> Env FAX:(805)525-41721 Ag FAX:(805)392-2063 FAX:(209)942-W23 FAX:(130)343-3907 FAX <br /> (So5)7 rl-* 2 FAX(559)734-8435 <br /> CA FLAP CeM iicoilon No.1573 CA ELAP CeMlSeadon No.1663 CA ELAP CorlMeation No.2670 CA FLAP Cerifitation No.2775 CA FLAP Cori fie800n No.2810 <br />