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M = = = CON "Cff Rffl5Rd' ' ' = M99!0 <br /> f <br /> ,MEW MP FOR LABORATORY USE ONLY <br /> 6 CRL Environmental Method of Tran rt Sample Condition Upon Receipt <br /> } Batch# D O # Walk-in 1 CHILLED Ye N❑ 4 SEALED YZ N 11 <br /> Corporation Courier ❑ <br /> 4630 Northgate Blvd,Suite 100 P 0 P UPS ❑ 2 HEADSPACE(VOA) YO N$5-5 OF SPLS MATCH CDC YZN ❑ <br /> Sacramento,CA 95834 ���� /y FED EXP ❑ <br /> Tel 916-925-1225 •Fax 916-925-1215 Logged By Date ,4 !)�imegt CRL 12 3 CONTAINER INTACT Yjd'N O 6 PRESERVED Y�'N 0 <br /> Client ,� Cc yrs k�w Address r C� Y qV r` �i TEL <br /> Attie 4Z-ur V G1 City G k a r-_ °ei State (J. Zip code FAX( � ) - <br /> Project Nam%e Project# Sp�; C Q 2 S mpler IPnmed Na <br /> I J r i/ <br /> Relinquished Mand F.ted Name) Date L3L Time Received tryS med NA41C Tim <br /> Relinquished by ,a nn erne) Date I Time Received by .m 9#Pnmed Name) Date Ttme <br /> Relinquished by are 4 Pnmed Na_) Date Time Received by pgnatum and Pained Name) Date Ti <br /> me <br /> SHIP TO LAB I hereby authorize CRL to perform the work indicated below Send ort To f Special Instructions/Comments _ <br /> lsus coNTAAcrI Project Mgr/Submitter Attn°�C�CIr r 1��.f �~ 3� 'C` /M�( s/-R <br /> TEST <br /> CAL p "/L"\7? t Date ! Co <br /> DATE Pnnt ame <br /> Address <br /> CLIENT f D Lp U A <br /> Signature City State Zip ` <br /> Unless otherwise Sample ArchivefDisposal Circle or Add o� cII <br /> ❑ Laboratory Standard CIRCLE APPROPRIATE Q A Q C <br /> Analysss(es) o MATRIX z RTNE EJ�' <br /> requested,all samples Requested `may Q0 p <br /> ❑ Other ro ao` O JZ _ RWOCB El <br /> will be disposed 45 days p Return To �° �� om fir" y� o�� �O� of F- DW ❑ <br /> after receiptF �° ° �� � NAVY ❑ <br /> *$10 DO FEE PER HAZARDOUS SAMPLE DISPOSAL ice ° v� :° Cc <br /> �j <br /> LAB USE ONLY ��'� Container(s) w CT <br /> Sample Description do °� �� a� o ^o �a s �° a yo 2 '0 OTHER <br /> E Batch# fid'' ° q ��m o� . ��¢��2 Q� ti�TAT # Type a REMARKS <br /> M Lab No Sample I D Date Time �° ° °ry °ry �ry o r o o o YP <br /> .11 <br /> 2 ac Al <br /> A Lo <br /> oto M/G'. 2 <br /> roc <br /> c f 3� <br /> -{pro _ <br /> V&el 1iE )-2S X <br /> •TAT starts B a m followingda if TAT A- Overnight B=Emergency C= Cntical U= Urgent E= Routine Preservatives <br /> y - _<24 hr Next workda 2 Workda s 3 Workda s - 7 Workdays H=Hci N=HNO3 S=H2SO4 C=4°C <br /> samples received after 5 p m <br /> Container Types T=Tube V=VOA L=Liter P=PInt J=Jar B=Tedlar< G=Glass P=Plastic M=Metal Z=Zn(AC)2 O=NaOH T=Na2S203 <br /> DISTRIBUTION White with report Yellow to folder,Pink to submitter <br />