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��"" a M M M M OWN WCIf�DWABIWAIRY MLM FIP09 Aff i <br /> C T <br /> Services. <br /> 1921 Ringwood Ave.•San Jose CA 95131 408 437-2400•FAX 408 437-9356 SERVICE REQUEST NO. P.O.kO PAGE OF L <br /> PROJECT NAME — C. pl0 .0 z ANALYSIS REQUESTED -- <br /> PRESERVATIVE NP HCI NCI HCI NP HCI HCI HNO NP H SO SO H SO <br /> PROJECT MGR. 1v1SG/ co <br /> ltiU <br /> COMPANY/ADDRESS _ V' CON <br /> ? w m <br /> 11 <br /> O Y=. <br /> GG a/l. Z a m `boor U S o 4 Q o <br /> PHO E D 7 OU .N �No `� ~�}nr '2mS zi a a°i r�-� Ur° <br /> LL Q C mO N <br /> FAX <br /> — Z O Ub ao o m ro h m y <br /> SAMPLERS SIGNATURE w �'+ rO O`er Uri O� o rj 33 a'c U ti <br /> SAMPLE LAB SAMPLE <br /> I.D. DATE TIME 1.D. MATRIX Z m� ��� ��m ~p h=� ti� O ��� ¢Q 22�tih0 do REMARKS <br /> HP-3- ,2.o' z4 k40-7 q- I <br /> f <br /> f]+TUEI F <br /> RE RIHE BY: R CEIV D BY' RELINQUISHED BY: RECEIVED BY: TURNAROUND REQUIREMYNTS REPOFrr REQUIREMENT_ 24hr 48hr. _�5day _L- rRoutine Reporttnature aur Ignature IgnaWre II.R n indudes DUP.MA .- e _ Standard(1015 working days) I <br /> arp� note ami- rinte came Printed Name MSDged required,may be <br /> (OC Provide Verbal Preliminary Results charged as samples) <br /> �) Provide FAX preliminary Results — III.Data Validation Report <br /> Firm I ^� /Ny� -Firm— Firm (includes All Raw Data) <br /> _ _ _. Requested Report Date RWOCB <br /> Da elfi a Date/Time Date/Time Oatelfime - (MDLSIPOLsRRACE#) <br /> RELINQUISHED BY: RECEIVED BY: SPECIAL INSTRUCTIONS/COMMENTS: <br /> Circle which metals are to be analyzed. <br /> Signature Signature Metals: At Sb Ba Be B Cd Ca Cr Cu Co Fe Mg Mn Mo Ni K Ag Na Sri V Zn <br /> note ame Printed Name As Pb Se TI Fig <br /> Firm Firm <br /> Date/Time Date mine �- <br /> � `` ��' ►`t�f�e Nol� w 3 <br /> DISTRIBUTION: WHITE-return to originator: YELLOW-lab; PINK-retained by originator 400-5 <br />