Laserfiche WebLink
Sample I Location/Description <br />IZ�rZL � <br />CORPORATE OFFICE & LABORATORY <br />P.O. Box 272/853 Corporation Street <br />Santa Paula, CA 93061.0272 <br />Tel: (805) 659-0910 <br />FAX: (805) 5254172 <br />Date I Time <br />CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />Sampler (s) :rte-�.L, N <br />Comp Sampler Set up Date: / Time: 090 <br />Time: Mileage: <br />Rush Analysis (surcharge will apply):' <br />❑ 5 Day ❑ 4 Day <br />* 2 Day ❑ 24 hour <br />Rush pre -approval by lab: <br />Inital. <br />Electronic Data Transfer: yes <br />If yes, To: State —Client p� +Other <br />Lab number: (.®5V �J l <br />lin fished by , d sub' terms and conditions on the reverse of this document: L .yam <br />Date / d Time �Relinquished by� Date Time <br />Received by: Date Q 041 Time I q0 <br />��__----1111---���� <br />Received by: <br />Date Time t�/W <br />/ <br />Relinquished by: Date fry J Time it <br />Relinquished by: <br />Date Time <br />Received by: _ Date ® Time M2 <br />Received by: <br />Dale Time <br />OFFICE & LABORATORY <br />FLED) OFFICE <br />2500 Stagecoach Road <br />a <br />� <br />Tel: (559) 7349473 <br />Tel: (209) 942-0181 <br />Mobile: (559) 737-2399 <br />FAX: (209) 942-0423 <br />FAX (559) 7348435 <br />a <br />a- <br />x <br />x <br />D <br />> <br />Z <br />v <br />QN <br />U <br />° <br />° <br />e <br />c7 <br />a <br />O <br />Lt <br />c <br />G <br />z <br />3 3 <br />P <br />N <br />v <br />a <br />3_ <br />a <br />c <br />(� <br />a <br />0 <br />0 <br />0 <br />C-4 <br />z <br />F <br />ra <br />to <br />-t <br />0." <br />Q <br />Rush Analysis (surcharge will apply):' <br />❑ 5 Day ❑ 4 Day <br />* 2 Day ❑ 24 hour <br />Rush pre -approval by lab: <br />Inital. <br />Electronic Data Transfer: yes <br />If yes, To: State —Client p� +Other <br />Lab number: (.®5V �J l <br />lin fished by , d sub' terms and conditions on the reverse of this document: L .yam <br />Date / d Time �Relinquished by� Date Time <br />Received by: Date Q 041 Time I q0 <br />��__----1111---���� <br />Received by: <br />Date Time t�/W <br />/ <br />Relinquished by: Date fry J Time it <br />Relinquished by: <br />Date Time <br />Received by: _ Date ® Time M2 <br />Received by: <br />Dale Time <br />OFFICE & LABORATORY <br />FLED) OFFICE <br />2500 Stagecoach Road <br />Visalia, California <br />Stockton, CA 95215 <br />Tel: (559) 7349473 <br />Tel: (209) 942-0181 <br />Mobile: (559) 737-2399 <br />FAX: (209) 942-0423 <br />FAX (559) 7348435 <br />