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MI-GTIK <br /> 4080 PIKE LANE, SUITE C 1✓1IN1IY-V! ���t VA.*i 81 .L.VJ$.. 2 4 Uyb <br /> CONCORD, CA 94520 * AND ANALYSIS REQUEST <br /> l � q <br /> NYIRONMINTAI 510) 685-7852 F l�rr t. �� r + 141 ,r '1 ►� 1 1 <br /> NIGRAW01116 INC 1800) 423-7143 <br /> Company Name Phone# <br /> f FAX# oOL✓ ❑ ❑ ❑ <br /> Comp y Address Site location ��� A� D <br /> u, ❑ ❑ o ❑ <br /> j�l� �- c 0 <br /> ry <br /> Pt Manager Client Project ID (#) 013 4lq47'�Z -- _ ❑ <br /> lr NAME N � R ❑_ ❑ ❑ ❑ `Z z ❑ Q ❑ ❑ <br /> I attest that the roper field sampling Sampler Name(Pr t) a © m g o ❑ ❑ 'a R <br /> procedures were used during the collection r ❑ a y p o 0 L3 <br /> a ❑ a co 0 L <br /> of these samples 8 D m �;, a $ ❑ ❑Ln <br /> '� o d <br /> Mat x Method Sampling a ❑ C3 a- a ❑ ❑ ❑ p d �J <br /> Field GTEL Preserved ,� r ❑ ❑ w w a `� ❑ ❑ d <br /> Sample Lab # Cd <br /> c p[ ❑ _ co 5 �1 <br /> { W W n r7f W [7 C <br /> ID (Lab use only) c3 o o _ <br /> : a o a v z W a a m a a a a nq a a a <br /> 3 N a vy a o x x x U oN o v m m = x 0 r�i w w w w w w w w w ci <br /> /V 171tvPq - 11 <br /> �✓ ` <br /> ✓ <br /> TTTT- <br /> TAT Special Handling PECIAL ET TIO LIMITS REMARKS fj O P <br /> —S�N�A� f r�el,�e Ike <br /> Norrly(24 hr) ❑ GTEL Contact <br /> Expediled(48 hr) ❑ OuotelConlrad# 7 <br /> 7 Business Days ❑ Confirmation I <br /> SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot # Storage Location <br /> 01her PO M <br /> Business Das ❑ <br />� QA!OC LEVEL <br /> I <br /> BLUE❑ CLP❑ OTHER FAX Work Order# <br /> Relinqu d by ampler. ate Time Received by <br /> h <br /> CUSTODY Relinquished by at Tim Received by <br /> RECORD Relinquished by <br /> Date Time Received by Labor tory <br /> 7 <br /> /��.� %11-aW���� waybio� <br /> Rqv 7141 '- <br />