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4080 PIKE LANE, SUITE C CND ANALYSIS rREQUEST'ORD 3 6 5 7 0 <br /> §GTEL 510 685-CONCORD7852 94520 <br /> �YY1�0•Y7M'Yl 800)423-7143 <br /> fAIO•A�•1111 <br /> Company Name Phone# b1 - t-I <br /> [� 2 <br /> FAX# �J l� Ll <br /> W II i7 9 El <br /> Stte Location <br /> ompany d ass [A I I I I m h Q [I <br /> /�/�/1 £ cn o u� N o I1 [] <br /> Client Project 1D (4) U ZOW011 U ± iQ F U <br /> Project Manager qo)a N �' <br /> U p o [1 11 ( l 1 1 z z ] [c 11 [ ¢ <br /> ME1i 1 I i m E g U ❑ <br /> I attest that the proper Held sampling Sampler Name(Punt) a Iy Q " tl l 1 0 a a vti <br /> t� n N I_1 t] m [] nN e <br /> procedures were used during the T o o no. , d 5❑� <br /> collection of these Sam les c o ° " m a @ t I m co I i a O ` vi iG U <br /> Method N D o v a a a a I I I l 1 [] a <br /> sampling c� II w a a U <br /> f Matrix preserved ❑ <br /> a <br /> 2 a m r t] [1 w w a a m v N N i N d <br /> Fielc! WGELm N H ❑ n ❑ a. <br /> Samplem m c� a o ` <br /> x mw w� w w x - - m a a a a a a a ~ °� a s <br /> IID Usec00 1 � � � � h v z d w H F� a � M r � a a o a � a a ♦a W a a v o <br /> — O x s x s 0 0 1= m m x s Ow u� w w w w ua w w u, cs OQ00 <br /> 0.4 <br /> LA <br /> • <br /> 1'D GLO t� <br /> REMA <br /> Special Handling SPECIAL DETECTION LIMITS <br /> TAT Pl"Nr <br /> Priority(24 hr) ❑ GTEL Contact <br /> Expedited(49 hr) ❑ Quote/Contract# � {J{JY <br /> 7 Business Days ❑ Confirmation# Lab Use Only Lot# Storage Location <br /> Other SPECIAL REPORTING REQUIREMENTS <br /> Business Days ❑ PO # 5 4 e~ <br /> t <br /> OA/OC Level Work Order <br /> Blue❑ CLP❑ Other❑ FAX(] <br /> ehn liethwi Sam&r ate Time Received by <br /> CUSTODY elan ulshed by Date Time RecQivod by <br /> RECORD Date Time Received by Laboratory <br /> Relinquished by g to -, 0 0 waybill 11 <br />