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M = = CON C ffRLR� �g !of <br /> FOR LABORATORY USE ONLY <br /> CRL Environmental Method of Transport Sample Condition Upon Receipt <br /> Batch# D O # Walk-in ❑ t CHILLED Y❑ N❑ 4 SEALED Y ❑ N <br /> Corporation Courier ❑ <br /> s <br /> 4630 Northgate Blvd,Suite 100 P 0# UPS 0 2 HMSPACE(VOA) Y❑ N❑ 5 #OF SPLS MATCH COC Y ❑ N ❑ <br /> Sacramento,CA 95834 FED EXP ❑ <br /> Tel 916-925-1225 •Fax 916-925-1215 Logged By Date Time CRL ❑ 3 CONTAINER INTACT Y© N❑ fi PRESERVED Y ❑ N ❑ <br /> L_f <br /> Client '��Ceu V1 � TEL ( j ) <br /> � <br /> 1 USG Address <br /> Attn �� C 5 City Sate Zip Code FAX( r ) - C <br /> Protect Name �) Protect# 7 mpler L 0 (Signa el <br /> Rehnqusshed by (Sgn n ied Nam Date Time Received a� ame) <br /> Dat Time © y <br /> Relinquished by tsrenatu eme}-' Date Time Received by is.g „re and Printed Name) Date Time <br /> Relinquished by (sg—tu."Priv Name) Date Time Received by (sigmtureawNntedName? Date Time <br /> SHIP TO LAB I hereby authorize CRL to perform the work indicated below Send RVortJo Special Instructions/Comments <br /> (sue CONTRACT) P tect Mgr/Submitter Attn ' <br /> TEST �� <br /> ti Date I / Com <br /> CRL N --- <br /> DATE Print Name <br /> Address <br /> CLIENT I 0 <br /> Signature City State Zip <br /> Unless otherwise Sample Archive/Disposal Circle or Add p, �u =} CIRCLE APPROPRIATE Q A Q C <br /> (D Laboratory Standard Analysis(es) mh o MATRIX Z RTNE ❑ <br /> requested,all samples Requested \mh ; o� O RW <br /> will be disposed 45 days El❑ OtheReturn r To ;,ti o m G� C� ooh pJ � r DW ED <br /> after receipt o �°HAZARDOUS NAVY ❑ <br /> *$10 40 FEE PER HARDOUS SAMPLE DISPOSAL mc° mg cod `a iJ �. g ¢ <br /> C'� o� a�' � �`' Containers) Lu CT, '� <br /> I IAB USE ONLY cr' Q" �° rn OTHER <br /> T Batch# Sample Description o �� moo` ao �� ° �Q �o o _ `� u, <br /> E �� a�° o� p�N ° N � ag �� OO P ��2 $� irk TAT # Type <br /> M Lab No Sample I D Date Time °° �° �ry �ry �o �° m O o¢ d Yp a REMAi4KS <br /> 7 Z 02 <br /> I <br /> j 3 <br /> -013 -L_ t 1 5 <br /> —O/S— At.L'�_l-3 lw� <br /> 114/-13 1615 e <br /> tt 5 <br /> 01q VA - j (21C <br /> I <br /> •TAT starts 8 a m following day if TAT A= �_tn <br /> B_ E rgency C_ Critical B_ Urgent B_Routine Preservatives <br /> - Next workda - 2 Workda s - 3 Workda s - 7 Workda s H=HcI N=HNO3 S=HzSO4 C=4°G <br /> samples received after 5 p m <br /> Container Types T=Tube V=VOA L=Liter P=Pint J=Jar B=Tedlav G=Glass P=Plastic M=Metal Z=Zn(AC)z O=NaOH T=Na2S203 <br /> DISTRIBUTION White with report, Yellow to folder,Pink to submitter <br />