Laserfiche WebLink
ACCUWB <br /> -0 Lakeville NlghIxay Petaluma CA 94962 <br /> Box a08024 Peplums CA 949768024 <br /> Telephone 170717636246 FAX (707)7834086 SAMPLE CHAIN OF CUSTODY/WORK ORDER <br /> Phone <br /> Client's Name p 9 <br /> Address 34 ec C- 4'r <br /> City,state,Zip ra o G A Z <br /> Client's or Representative's Signature <br /> (signature authorizes the work and terms Ii a elow) <br />' All samples remain the property of the client who is responsible for disposal A disposal fee may be Imposed If client fallE <br /> to pick up samples <br /> PROJ NO PROJECT NAME <br /> © I Z A F FG REMARKS <br /> SAMP ( rgnatwe) '46 OF <br /> LAB <br /> OF USE ONLY <br /> CON- LAB NO <br /> STA NO DATE TIME Ca STATION LOCATION TAINERS <br /> O Q <br /> U O <br /> REWIC b4 , 1 x x <br /> x x <br /> TP, EWC4 3 x <br /> Z � q rs�� Np - I x >( <br /> q 31—AN D-2 k <br /> I_AtlD -3 <br /> �a 61--A <br /> ATE TIME Reserved by (Srgrlature) General Remarks <br /> RaImqu h by (Signature) a y H tiV�l <br /> R i hod rgnarure) DATE TIME Received by (Signature) <br /> Rehrtqurshed by(Signature) DATE TIME Reserved by (Signature) <br />