Laserfiche WebLink
4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODYRECUHIJ <br /> GIRLCCOfNCOpCRD,, CA 94520 S AND ANALYSIS REQUEST20II (510) 685-7852 �* ijt �< 1F 'si f=ll�%cr �i • <br /> l� lAI0YAr0lIII INC (800) 423-7143 E 7 <br /> Company Name Phone# 3 �� <br /> FAX# 0 S� a -e <br /> ❑ m ❑ <br /> Company Address Site location 'I' x ❑ <br /> IItC� ►� C] x <br /> - N ❑ IL © <br /> l[Q ❑ <br /> rolect onager Client Project ID (#) Q,20$"Q 700 # H + + ❑ a <br /> W cn m r N CP <br /> It K s � }r° nCr `/G�,p oodMCa � Q�C ❑�❑ ❑r } ❑(V ❑ ❑ ❑m zJQo Q U o <br /> ❑YJ.. <br /> �p,� vh❑ <br /> LL <br /> ❑ a❑NAME H ❑ <br /> I attest that the proper field sampling Sampler Name(Print) ❑ a " ❑ 0 Cn <br /> J U m <br /> procedures were used during the collection a ❑ rof these samples . R a �m! 'Method a o r- " <br /> Matrix Sampling ;E UO- <br /> 9 r-ae) 0- 1111 <br /> ❑� ❑ ❑ a� � ❑� x� ❑Preserved ❑ WW ❑Field GTEL ❑ vSample Lab # W <br /> ID (Lab use only) 3 W o W o W W W °` o <br /> 4 p a: � � Fes- Ij z �. W IE �a Q � H I- >• �• --- a O 0. a d d d d d 0_ U d Q <br /> di a rn a o x x x �? o F m m x z o F- w W ui W W w W W W H W U 5 0 0 <br /> f a� <br /> I L <br /> TAT Speclal Handling SPECIAL DETECTION LIMITS REMARKS <br /> Prfonly(24 hr) ❑ GTEL Contact <br /> Expedited 148 hr �. Quote/Contract N <br /> 7 Business Days ❑ Confirmation N <br /> SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> other pp r <br /> Business Days ❑ 1 Y6i&4LS �y /J44�� <br /> OA I OC LEVEL 4j*29 <br /> BLUE❑ CLP❑ OTHER FAX El /*VVJP7V -WI Work Order# <br /> Relinquished by Sampler AK <br /> te Time Received by <br /> CUSTODY I <br /> Relinquished by Date Time Received by <br /> RECORD Relinquished by, Date Time Received by La oratory <br /> Rev 7IG1 <br /> 1 V vWay # <br />