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VN --v-1 02233 <br />1 - - <br />6001 Shellmound Street, Suite 700 <br />Emeryville, Colifornia 94608 PAGEof <br />(510) 655-7400 ty�, <br />(510) 655-9517 (fox)uS{pq S 7N <br />PROJECT NAME / FACILITY ID: `�A �ncr�y 'C �°�oat5 IAL FIELD PERSON: 3 <br />: <br />03'3SlKA DATE: PROJECT MANAGER: +'. <br />VA <br />PROJECT NUMBER <br />PROJECT LOCATION: 0 s� •+- LJAL <br />t! Rly'l.+11 Inc. <br />IS THIS A UST PROJECT OR IS EDF REQUIRED? Y GP IF YES, GLOBAL ID #: _ WO#: <br />SAMPLER: / ; <br />YEARo <br />Ot+# <br />W~ <br />xN <br />N <br />o <br />�% <br />�O <br />Li *'+ ' "n <br />SIGNATURE: <br />Q <br />W <br />W <br />W <br />Qia <br />o <br />z <br />Q SO <br />> <br />SAMPLEI.D. NUMBER0 <br />aco <br />~ COMMENTS <br />V) <br />z <br />U. <br />a. <br />is <br />/0 /1 <br />W CO <br />W A <br />S <br />1 <br />u. <br />1Jo <br />Uj <br />II <br />�l <br />11 <br />TOTAL <br />IXIXIX <br />X <br />Xl <br />X <br />I <br />1I <br />I <br />RELINQUIS TIME DATE: <br />z <br />R TIME DATE: <br />TURNAROUND TIME SAMEDAY 72 HOURS <br />(CIRCLE ONE) HOURS 5 0 II <br />• / <br />'.- <br />(CO <br />24 <br />48 HOURS NORMAL <br />Q S 8 ' TIME/DATE: <br />EIV BY: TIME/DATE: <br />SAMPLE INTEGRITY <br />Its— <br />INTACT: Y N Temp <br />INTACT: <br />if SEALED, SEAL INTEGRITY <br />INTACT: Y N <br />(j <br />(COMPANY '� <br />NQU SHE TI E/DATE: <br />RECEIVED BY: TIM ATE: <br />COMPANY <br />Page 8 of 8 <br />