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ZACo� M �� 60W"O S"0Y�30�T0MAhftY t awrvan <br /> ces0� 3334 Victor Court•Santa Clara,CA 95054 SERVICE REQUEST NO P O# PAGE OF <br /> E o„�neo ca. -y (408)748-9700•FAX(408)748 9860 <br /> ANALYSIS REQUESTED <br /> PROJECT NAME `�3Z 5 # PRESERVATIVE HCI HCI HCl NP NP NP HCI HNOJ NP H SD, NaDH <br /> PROJECT MGRL Cn m p i U vv-Ov <br /> �� �p <br /> COMPANY zCO <br /> ADDRESS <br /> ADDRESS z <br /> 1f7/'lY <br /> PHO - 0 CO Qac `W 0 <br /> 0 �m <br /> FAX "" mD o`�o m y uo 4 "m °� (j0 pa <br /> O o,a 0ro� m N o �4 c 4 '0 O <br /> rt O N m 0 0 Q � ro e <br /> SAMPLER'S SIGNATURE m m m h m ca a0 ct V° <br /> SAMPLE LAB SAMPLE 0 0 0'o ro U c,4 .: AIL <br /> 2� m� Z �., c <br /> z ry 2 a ti�a ti��mroN 4 a� i-� �'1° aQ �2 U� REMARKS <br /> ID DATE TIME ID MATRIX �n w O <br /> 4 <br /> 6-'6/-5-M TPH <br /> 13 cc <br /> L,-"ATM - <br /> c/JPL- 3 xX' <br /> I ho � <br /> R -ei 015fSS ,�-r6 3XKI <br /> � fv <br /> 6 S x <br /> E NQUI H BY EC D BY RELINQUISHED BY RECEIVED BY TURNAROUND REQUIREMENTS REPORT REQUIREMENTS <br /> N.- — ! Routine Report <br /> Si re Signature Signature <br /> 1 day _2 day_3 day II Report(includes MS <br /> 2Prinried <br /> re S 9 5 day _Other _ MSD,as required,may be me Pr ted ame Printed Name Printed Namecharged as samples] <br /> Standard(1D workrig days) _ III Data Validation Report <br /> Firm Frrm (includes A41 Raw Data) <br /> C� Frr �-7,r (� Results Due MDWPQLslfrace# <br /> Date/Time J Date/TimUeo 1 Date/Time Don ate lTrme Electronic Data Dehvesables <br /> RELINQUISHED BY RECEIVED BY SAMPLE RECEIPT Condition Custody Seals <br /> SPECIAL INSTRUCTIONS/COMMENTS <br /> Signature Signature Circle which metals are to be analyzed <br /> Printed Name Printed Name Metals At Sb Ba Be B Cd Ca Cr Co Cu Fe Mg Mn Mo Ni K Ag Na Sn V Zn <br /> As Pb Se TI Hg <br /> Firm Firm <br /> Date/Time DatelTime <br /> Storage <br /> Shipped VtalTrackin # <br /> *VVrlt sample results be used in connection with drinking water regulattons7 ❑ Yes KNo If yes,you must so indicate by writing"DW'for each such sample <br />