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3461 <br />Sampled and Relinquis ed by. <br />f/ 3 <br />(� <br />ware 1 ime <br />Til <br />Relinquished by: <br />R y: <br />CES COC # <br />Received br. <br />T <br />l <br />COC <br />Version 6.0 <br />R . a . <br />17151 <br />10/12/2006 <br />r i <br />111111111 IN <br />Turnaround <br />Send Results to: <br />Time <br />Field Contact K..NEWMAN <br />Data Package Required: g q tRNormal ❑CLP <br />jvi <br />Reporting level: ❑ Level I ❑ Level 2 <br />❑ Level 3 <br />A. GRAY50N <br />El R3293 <br />59 <br />❑ RETURN UNUSED SAMPLE TO CLIENT <br />627 <br />22300 <br />®N <br />LLNL Account # <br />_ <br />Cie I/'r�ti <br />EDD Required (data from off-site labs only) <br />L_ <br />phone <br />,T, <br />Client ID RHWM <br />Copy: K. NEWMAN <br />Project Name <br />L_ 874 <br />_-J <br />' <br />DQO: <br />2,400 <br />Condition Upon Receipt: o Discrepancies <br />N/A <br />Tank Volumeliters <br />❑Condition/Variance <br />Tests <br />/ Preservation <br />Codes <br />Additional Instructions: <br />Client Sample <br />Date <br />Time <br />R -A D <br />Matrix <br />Gen <br /># of <br />Identification <br />Sampled <br />Sampled <br />Bldg <br />(YIN) <br />Code <br />Code <br />Bottles <br />I <br />0 <br />;z'" ''7 <br />3 <br />Sample Composition <br />W311145 l <br />11/13/07 <br />0930 <br />87S <br />N <br />AQ <br />3 <br />(� <br />A <br />S <br />AQUEOUS <br />NRr <br />2 <br />3 <br />4 <br />5 <br />6 <br />7 <br />8 <br />9 <br />Sampled and Relinquis ed by. <br />f/ 3 <br />(� <br />ware 1 ime <br />Til <br />Relinquished by: <br />R y: <br />Relinquished by <br />Received br. <br />-, ___,._p_ _ ._. ____ _._ _.........,._. EL.AP Certifications q 1554 <br />- be worker certifies that the Smedard ES&H Rotes, Responsibilities and Authorities defined by Service Category 1 described by Section 4.3.1 of Document 2.1 "Laboratory and ES&H Policies, General Worker <br />Responsibilities sal Integrated Safety Maaagernent," apply and that the IWS or fWSs authorizing the work have the appropriate controls for the h—rds involved in the task/analy6s." <br />For document control purposes, user SHALL ensure that all working copies are identical to current electronic vection, <br />http:t/cm&linl.gov/ces/QA-Docs/QA_Doa.html <br />