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M M M M M M M Mm ti m M M M M M <br /> HPDR <br /> ! Swool/3. ,� OBatch No <br /> W. <br /> ENVlRChain MENTAL of Custody CA PO-2173 <br /> TECHN V, OGLES, INC. <br /> 2394 Magner Square Dnve,Suite 2, Alameda,CA 94501 Page or <br /> 510-521-2684(voice) 510-521-5078(fax) Date 5/ ( /20x1 <br /> Lab Name Cliromalab, Inc Analysis Request <br /> Address 1220 Quarry Lane <br /> Pleasanton, CA 94566-4756 o o w <br /> C3 <br /> A <br /> Telephone 925-484-1919 w c u o N u m a Q <br /> E- a ' y N <br /> y/ <br /> Sam rs(S1 ur / [— E - c r-e r w G [ � Q 9 iq Q y N � E O � y <br /> t° a�O a � � � � mo <br /> > <br /> E <br /> Q L (} A v CC U Q y <br /> �1 LZ5amp Number Matrix Location pmp >00 }o > N .d <br /> 1 010501 [ 355 water MW-1 X I X I - <br /> 2 <br /> 2 010501 1-3n5- water MW-2 <br /> 3 010501 { ( 5 water MW-3 <br /> 4 <br /> S <br /> 6 <br /> 7 <br /> g <br /> 9 <br /> IO <br /> Project Information Sample Receipt Relinquished By 1 Relinquished By 2 Relinquished By 3 <br /> Project Name Total No of Containers <br /> Central CA Traction Co <br /> Protect Manager Chain of Custody Seals (St re) � (Trine)(Signature) {lime)(Signature) irt ) <br /> Avakian <br /> Job No Rec d Goad Condition/Cold (Printed Name) (Date)(Printed Name) (Date)(Printed Name) (Date) <br /> 007-3461 X3.0 1 zap 1 <br /> Shipping ID No Conforms to Record (Company) (Company) (Company) <br /> Lab No Received By 1 Received By 2 Received By (Laboratory) 3 <br /> Via Hand i--- L�� <br /> (Signature) (Time)(Signature) (Time)(Srgnarit .+f�� <br /> Special Instructions/Comments '� V. / IS <br /> Standard Turn Around Time (Printed Name) (Date)(Primed Name) (Date)(Printed Name) ! D` (Date <br /> S �-Gi- <br /> (Company) (Company) (laboratory) I <br />