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OGTED 4VOU 1-1f\L- JC L--%t VI I L, %--fisav %00V <br /> � vv�v✓• ■�ivv��✓ Z b 118 i.! <br /> CONCORD, CA 94520 i AND ANALYSIS REQUEST � <br /> NY 1 1e ON M e N r ACL 510) 685-7852 ' e <br /> LAf01A10l1lf INc 800) 423-7143 <br />,otnpany Name Phone# <br /> C:"T ° <br /> FAX# ❑ ° -2 O t\ <br /> 7 I V <br />:ompany Address Site atl n _ <br /> 0 CI <br /> C-6 N ❑ � ,- c`r3 is ❑ ❑ <br /> ro ec snag r Client Protect ID [V-Z6� � 0 J U y o � <br /> NAM N 2U ! ❑ ❑ 13 Z' <br /> 3 z z ❑ � © ❑ ❑ <br /> attest that the proper field sampling Sampler Warne(Print) a ❑ o a* ❑ A ❑ ❑ ❑ <br /> m � � t3 � <br /> nocedures were used during the collection �? � ❑ ❑ ❑ y ka <br />)I these samples r N ❑ r" *- ILS - ° a� ❑ <br /> Method m a o a ❑ <br /> Matrix Sampling ❑ ❑ ❑ ❑ <br /> Preserved ❑ P� ❑ f <br /> 2 <br />� Field GTEL ❑ � ❑ � a � ❑ ❑ � <br /> Sample Lab # Ill ' s � I ^ ° ° ° x C <br /> Lab useonl � � w — � � <br /> 3 c°n a a o s = i 5�o F fn i = 6 B u°3 �i1 �fi1I iii iii laic �3, I a c� <br /> I IN <br /> Mmw X1 <br /> 5I IN <br /> AD 4K <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> -Vlf'oSf- 111 ' 71 FD �ea9 Z3 <br /> Priority(24 hr) ❑ OTEL Contact <br /> Expedited(48 hr) ❑ fluotelContract# ""• T <br /> 7 Business Days ❑ Conflnnow# <br /> Other ,tum PON SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> Business Days ❑ <br /> OA I OC EVEL <br /> BLUE❑ CLP❑ OTHER FAX Work Order# <br /> Relina Sam ler Da Time Received by <br /> —dl �:� <br /> CUSTODY Relinquished by Date Time Received by <br /> RECORD Relinquished by. Date Time y Laboratory <br /> We III <br /> Rev 7191 <br />