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Main Labs ?.?a=CHA1 OFCUSTODY.RECORD=- s J" <br />,d Gillette, WY This is a LEGAL DOCUMENT. All shadeo?.rlelds must be completed. See reverse for instructions. N? . 122428 <br /> Project Identification <br /># <br />S ler (Signature/P ted) <br />Tele <br />hone <br /> <br />.i r.•- <br />17 <br />- <br />p <br />?T- <br /> <br /> Contact Name <br />.s ANA LYSES / PAR AME TERS <br /> <br />y <br />) c, . ; <br />n9?y'Y <br />3 .J } <br />I <br />rF tom, <br />t ?L <br />Y? <br />. <br />Email <br /> <br />_i, t J <br /> <br />- <br />??- - r-- Phone .: ?}= fl '-- ! s. d y t <br />r Purchase Order # Quote # t r t <br /> REMARKS <br />TIME SAMPLE # of ; <br />D. 1 IDENTIFICATION Matrix Containers . <br />r r <br />= <br /> <br /> <br /> <br /> rte. tl ? , ? ? <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> ih <br />• <br />• <br /> ? <br /> ? r <br /> <br /> <br /> <br />T • • W <br />btl Check desired service -? <br />SL GI?rStandard turnaround • C •' • ADDITIONALiREN <br />Compliance Monitoring? <br />Program (SDWA, NPDES,...) <br />SD ? USH - 5 Working Days PWSID / Permit # <br />I B Q. URGENT - < 2 Working Days <br />Chlorinated? y/ <br /> <br />OT Rush & Urgent Surcharges will be applied Sample Disposal: Lab 'Client <br />Rev 4.5