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[A <br />so , - e <br />Weck Laboratories, Inc. <br />ENVIRONMENTAL SERVICES <br />14859 E. Clark Ave. - Industry, CA 91745 - Tel: 818 336-2139 Fax: 818 336-2634 Pae �f <br />rY ( ) ( ) g <br />CLIENT NAME: PROJECT: <br />10 �4, <br />S.jow'A <br />ANALYSIS REQUESTED <br />SPECIAL HANDLING <br />❑ Same Day Rush (60%) <br />❑ 24 HRS (40%) <br />❑ 48 - 72 HRS (30%) <br />7 - 10 Business Days <br />❑ QA/QC Package <br />Reporting Agency <br />Method of Shipment: <br />It <br />�, <br />— <br />ADDRESS: PHONE #: <br />e _ <br />PROJEC MANAGER SAMPLER: / P O.# <br />LAB _NFE TIME SMPL PLE IDENTIFICAT N # OF <br />I.D.# SAMPLED SAMPLED TYPE' CONT. <br />9 13y <br />REMARKS <br />Xn f civ <br />Com- <br />rtC L <br />L <br />QC� <br />RELINQ ED BY . <br />DATE/TIME / <br />ECEIV BY <br />' = AQ - Aqueous NA - Nonaqueous SL -Sludge DW -Drinking Water <br />WW -Wastewater GW -Groundwater SO -Soil SW -Solid Waste OT -Other <br />LINQUI ED BY <br />DATE / TIME <br />t� , — <br />RECEIVE <br />/ <br />(/ <br />Sample Condition: <br />Precooled Y <br />Preserved Y / <br />Evidence seals intact Y / N <br />Container Attacked Y / N <br />Preserved at Lab Y / N <br />Disposition of samples: <br />Pick Up by client: <br />Return': <br />Dispose by Lab': <br />` Extra charge added <br />RELINQUISHED BY <br />DATE / TIME <br />R EIVED BY <br />SPECIAL REQUIREMENTS OR INSTRUCTIONS <br />EZ PRINTING 17141 526-5553 FORM 101 <br />