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CONCORD CA 94520 AND ANALYSIS REQUEST <br /> IN TP L (510) 685-7852 ' <br /> M11111 !lt��oltt�iNilAia (800) 423-7143 <br /> Con�No, e: Phone N, <br /> FAX C p ❑ <br /> •r { y 1 Site cation' ❑ ❑ o <br /> i ! W <br /> _) Ig <br /> Pro n �Ir Client Projdct ID (y1 t ❑ I j <br /> 12 <br /> NAME r ❑ 0 p z z ❑ ❑ ❑ <br /> I at�4itj10 Q 4 ld a p n Sam ler Name(Print) a ❑ o ❑ ❑ o ❑ ❑ <br /> prxp6res,WAre i during the collection � t ❑ ❑ <br /> of these sam fes �1V ❑ a o o O ❑ o. o ❑ t <br /> Method Sampling " o Cn o < a ❑ > " 7 <br /> r Matrix p g Q ❑ ❑ ❑ <br /> E Preserved ❑ W w w a � S3 ❑ d y� <br /> Field GTEL !� <br /> ❑ = m m a d ❑ <br /> Somple Lab # d tr � � " � <br /> II (Lab use only) D ° ffi IS <br /> o w d o ' W = m a a ¢ a ¢ a a < r <br /> 3r9iacna0 � <br /> fill <br /> 7 <br /> Io <br /> 0 <br /> ti <br /> t, 2 Z <br /> 5 <br /> MOD <br /> i <br /> i f51 r <br /> r <br /> TAT 'Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> PH"(24 hr) ❑ GTEL Contact <br /> Expodned(48 hr) ❑ QuotelContract M �. 3 r o b �. � YL'v- <br /> 7 <br /> 7 Bust[nKs Days ❑ Confirmation N <br /> Other Co � SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot� r 11 Storage Location <br /> ' w r Bonn , ❑ QA!QC LEVEL ' i TOC/ <br /> BLUJ d CLP❑ OTHE FAX❑ Work Order# <br /> I <br /> Rolf Ish d by Sampler Date TimeXR;;� <br /> � 630 <br /> CUSTODY Relin ! d by to Time <br /> 7 1'6— <br /> RECORD <br /> `6— <br /> RECORD lnquf d Date Time Received by Laboratory <br /> Rev int d" 5 Wa i!I# 1 <br />