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4080 PIKE LANE, SUITE C ANDIANAL YSIS REQU STDRD '-8354--- <br /> T8354T E L CONCORD, CA 94520 <br /> (510) 685-7852 ��a <br /> LA NTT0RIIESN INC (800) 423-7143 <br /> ,ompany NamE Phone# r ,, n 71 ` <br /> a <br /> FAX# ❑ m,omx Q ❑ <br /> �j,� �� Site location "' `' <br /> p,ny Adr.f C r� ca+ c, I S"`F'Y `� L1 Guy`/ _ �' m <br /> / ❑ © ❑ Q o ❑ <br /> 6, c ,1,' Cit 'a i.� . Cyt 1 << tr ❑ ,Ln N v ❑ © , <br /> Client Project 1D (#) ✓:�L)-7 t - V � i ❑ °; ± v ❑ a <br /> ro)ect Manager ❑ „ �„ N <br /> coi- a m m z p ~ <br /> �I� �^ v afa-`-✓ NAME ?LK7G+P -o s ❑ O ❑ ❑ E © ❑ ❑o ❑ <br /> attest that the proper field sampling Sampler Name(Print) 3E a_ 0 0 v ❑ S p o cn J <br /> procedures were used during the collection f ❑ " ' N ❑ ❑ m ¢ ¢ `� - a <br /> 1 0 0 r!j u4i o 0 oU o C) m ❑ a ❑ <br /> C r't(Jv\ Cir C 3i]?. ❑ n r N v n a ¢ ❑ n <br /> )f these samples N m LL m r, 2 U m � ❑ ❑ U o U o <br /> Matrix Method Sampling coco co <br /> a p o w a a ❑ ❑ p a N ❑ u- <br /> (� <br /> Preserved <br /> Field GTEL ❑ _ _ ro ❑ ❑ w w a a N N N ❑ ❑ <br /> Lab # m g ❑ o ❑ d n- ❑ =C> W � N _ <br /> Sample 0co 0CU <br /> D CW7 o ¢� co a c a a u�, w c� W co O a N fn <br /> (Lab use only) U F - 0 = p o Q Ww rw- W w v � .a z m ¢ ¢ a a ¢ ¢ a ¢ rn <br /> r z U Z Z �N¢ f r �, 7, - n 0 a a. a_ a s a. 4 a U n ¢ ao <br /> y ¢ Cl) a 0 S z = o r❑ i= ca m 2 2 0 H ul w w w w w w w w f— w U i D U <br /> w - ? ") � 1�, Iii-r�+ ►3s:.� <br /> IJ 1''4 1 +,;a <br /> r � <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Priority(24 hr) ❑ GTEL Contact <br /> Expedited(48 hr) ❑ Quote/Contract# <br /> y Business Days ❑ Confirmation# <br /> SPECIAL REPORTING REQUIREMENTS nly Lot# Storage Location �'- <br /> Other PON <br /> Business Das ❑ <br /> QA 1 QC LEVEL <br /> BLUE❑ CLP❑ OTHER FAX❑ Work Order# <br /> Relinquished by Sampler / Date Time ReIeived by <br /> CUSTODYRelinquished by Date Time Received by <br /> RECI Relinquished by Date Time R Eetved' y Laboratory <br /> MW <br /> M l� <br />