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CMN R Cftpff RA%R&" ' = = M 9 _of <br /> FOR LABORATORY USE ONLY <br /> CRL Environmental Method of Transport Sample Condition Upon Receipt <br /> Corporation Batch# D O # Walk-In ❑ 1 CHILLED Y❑ N❑ 4 SEALED Y ❑ N ❑ <br /> Courier ❑ <br /> V <br /> 4630 Northgate Blvd,Suite 100 P o# UPS ❑ 2 HEADSPACE(VOA) Y❑ N❑ 5 d OF SPLS MATCH COC Y ❑ N ❑ <br /> Sacramento,CA 95834 FED EXP ❑ <br /> Tel 916-925-I225 •Fax 916-925-1215 Logged By Date Time CRL ❑ 3 CONTAINER INTACT Y❑ N❑ 6 PRESERVED Y ❑ N ❑ <br /> Client C4CM1 [�u Address r TEL ) t r <br /> Attn Iva City State Zip Code FAx <br /> Project Name j Project# ^�I� ampler (Pnnted Name) (Signature r <br /> Relinquished by isrs dijed Name- Date Time I Received by a and Pn ttad Name a �C Time <br /> Relinquished by 10 Name) Date Time Received by iS,V*Wre r Pnnted Name) Date Time , <br /> Relinquished by (signaA, and 6nted Name) Date Time Received by ISl at. and Punted Name) Date Time <br /> SHIP TO LAB I hereby authorize CRL to perform the work indicated below Send RaDort}To 1 Special Instructtons/Comments <br /> (sue CONTRACT) Pr ject Mgr/Subm er Attn 2 C P,, Sr /V Q <br /> TEST <br /> CRL a ^ 7 fi l i r Date / / Co _V_L L <br /> DATE Pnnt Name <br /> Address <br /> CLIENT 1 D <br /> Signature City State Zip <br /> Sample Archive/Disposal Circle or Add v CIRCLE APPROPRIATE Q C <br /> Unless otherwise Analysis{es) �,�~ y F MATRIX Z RTNE ❑ <br /> ❑ Laboratory Standard ,m <br /> requested,all samples Requested mq m <br /> will be disposed 45 days ❑ other c �o 6 y �� ��, J�¢' RWOCB ❑ <br /> ❑ Return To a Vm JO \p Q DW ❑ <br /> after receipt o 2 <br /> *$10 00 FEE PER HAZARDOUS SAMPLE DISPOSAL mac° �° a°�g C� �C v� t :° �� > NAVY El <br /> �� o o o Q� O� a3� ��� Container(s) Lu OT <br /> LAS USE ONLY Sample Description g Z m � �' <br /> T Batch# po`m �a s �o Lu OTHER <br /> m` �o REMARKSE Lab No Sample I D Date Time TAT #rType <br /> C73 <br /> a V,G<S IV Z <br /> I <br /> FJ <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br /> •TAT starts 8 a m following da if TAT A= Overnight B_ Emergency C_ —cal D- Urgent E- Routine Preservatives <br /> 9 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=Na2SzO3 <br /> DISTRIBUTION White with report, Yellow to folder,Pink to submitter <br />