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ENGINEERING ,�, <br /> ?000 <br /> INCORPORATED 0 or <br /> ' nnod <br /> SAMPLE CHAIP OF CUS DY / WORK ORDER <br /> Client's Namerd <br /> Phoned <br /> Address d <br /> City, State,Zip <br /> Client's or Representative's Signature <br /> (signature authorizes the work and terms listed be64) <br /> 'Terms: Payment is due within 30 days of invoice. A service charge of 1.5%will be added to overdue accounts. <br /> —All samples remain the property of the client who is responsible for disposal.A disposal fee may be imposed if client fails to pick <br /> up samples. q09 <br /> w ��� • <br /> • <br /> PROD No PROJECT NAME <br /> `AMI'1. IS:i tilpwhi+ul NO + <br /> OF REMAHK`.i <br /> CON• <br /> lSI, NOAll TIME IL a STATION LOCATION TAINERS <br /> U a: <br /> It <br /> 11 1 <br /> sa �- ,a,•�sCl SE <br /> �� rt $A,/ <br /> 6/7 5t �� r w• !,r _ `C. E <br /> 1 <br /> I <br /> Relmgwahed by.(Siflnaiura) Dale Time Received by:fSrpnaluro) DRIvINO TIME. <br /> STARI FINI:iH i DTA1. <br /> Roiwgwstied by ISryridrui e) Dale rime Received by:(S`+gnalura) SITE TIME. <br /> STAnT. I-INiSH TOtAt <br /> lluhngm shed by Iti,yn.nwu/ (O (1ldn IJnuu [Fhc"41.vw by Is,y,� turd) AL 111,11. 11 L`,IIUUR rARL r <br /> LIUII <br /> AGE. Jk <br /> . <br /> 40 <br /> P.O. Box 5853 • Concord, California 94524 • (707)74�J -6699/FAX(707)746-6815 <br />