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` : 4080 PIKE LANE, SUITE C AND ANALYSIS REOUESTORD 28945 <br /> �� E L <br /> CONCORD, CA 94520 <br /> ENVIRONMENTAL (510) 685-7852 <br /> � LA80RA RIES INC (800) 423-7143 I _ <br /> ompany N Phone# <br /> ° ° <br /> 7/xOrIN1>Lti�� r ti,� �rr�� I}L v i FAX# 0 � � ❑ <br /> ompany Address , Site location LCo u 2 z ¢ ❑ <br /> eVSia c,t�i fJ G4L ��` r N a ai ❑ ❑ <br /> Ln <br /> reject Mana er Client Project ID (#)r' ,l n �J X y + 11 N ca <br /> CD <br /> 'R � 1�. i; f�/��-�-I- /� NAME MIIVr,1 �U ❑ El ❑ ❑� z CO ❑ : ❑ El <br /> 13 65-attest that the proper field sampling Sampler Name(Print) a ❑ g ❑ o n v <br /> rocedures were used during the collection y i j y m N m ¢ a m 0 h o <br /> f these samples r'l' ' 7 J ''�y ❑ Q "3 L C o Q a v n a ❑ <br /> N � m cv LCn m ¢ m co m m O $ V o cz <br /> e Matrix Method Sampling o `d— o a ¢ ¢ m a d o N ❑ <br /> co <br /> Field GTEL Preserved T y N ❑ ❑ w w C* ❑ ❑ � ❑ a ° <br /> Sample Lab # ~ ° a LO ° ❑ ❑ ❑ a a ❑ 0 N <br /> C W N M N co v 'A O GM V <br /> o ¢ cc 4w C7 v o CG a t� cD O N c N <br /> �� Lab use only) a a Q m 0 ° IT— a vcc S a n � _° 0. o a a a a a a a a a r-- <br /> _j <br /> e <br /> 3 cn ¢ W o- o x x x o o r m m = x o r w w w Lli LU Lu Lu w Lu I- w v a o U <br /> /141 /3101XX I <br /> /\ <br /> r � <br /> �1 ,s A102 <br /> s oa <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS Iv, f I4 h <br /> r f`1 <br /> 'npnty(24 hr) ❑ GTEL Contact <br /> Expedited(48 hr) ❑ Quote/Contract# <br /> 7 Business Days ❑ Confirmation# <br /> SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> Other PO# <br /> 3usiness Das ❑ <br /> QA I OC LEVEL r <br /> SLUE❑ CLP❑ OTHER FAX❑ Work Order# �)��( ,C.. <br /> Relinquished by Sampler Date Time Received by <br /> CUSTODYRelinquished by Date Time Received by <br /> RECORDRelinquished by Date Time Received by Laborato <br /> 8V=1 _ MAS I <br />