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!1 17 Lode Palin A%cime <br /> (WVTAO" <br /> Suile 13 <br /> Alodcslo (.A*1 <br /> ns � ncrA T E s rrrr <br /> Company Naim, Al G flSca4c 1Cj.A-�- - ltv -- — _ Project Name- —� �xQP. Jk1 <br /> fvtaiErny AdrlrpaG - � __ <br /> I I IL Billing Address (if different) <br /> City - - - - State Zip Code <br /> Tplephone rl 97FAX H '��` �"�22ZS� PO ft — <br /> ! Y` >u SamplerS QC Data Level D (Slandaid) U Level C U Level B U Level A <br /> Turnaround ' 10 Working Days U,3 Working Days U 2 8 Hours U Drinking Water Analyses Requested <br /> Time U 7 Working flays U 2 Working Days U Waste Wate / <br /> 'J 5 Woikrng Days U 24 Hours 09Uher <br /> Client <br /> Date/Time Matrix t# of Cont <br /> Sample I D Sampled Desc Cont Type Sample Comments <br /> S 0 i /"TIC i5 <br /> -fid <br /> MvJ Z- -1305 -- -- _ _ �/ `� z0 CSO t �- <br /> byrunrtv�� <br /> 3 1330 OM 0)Lmh 6! <br /> it --- -- -- <br /> 10 <br /> Relinquished By — �� � le lj Tinie ,St) Received By Date �, ,�,�o Time 3 so <br /> Relinquished By Date — Time Deceived By Date Time <br /> Relrnqurshed By Date Time Received By Lab Dale Time <br /> Wet Samples Rei erved in Good Condilion? U Yes U No Samples on lce?Ayes U No 1 Aelhod of Shipnt at�)IJ F I a Page � of <br />