Laserfiche WebLink
CHAIN OF CUSTODY / ANALYSES REQUEST FORM J0LI7 <br /> SAMPLE COLLECTOR; I PROJECT NO.: SECTION NO.. DATE: SAMPLER'S INITIALS: SERIAL <br /> lee LFR 4190 Douglas Boulevard, Suite 200 rPRK0JEi;�; <br /> C4 t�` r n Granite Bay, California 95746-9460 N E: SA FRER(S lun1: <br /> LEVINE•FAIIRE (916) 786-0320 Fm: (916) 786-0366 <br /> SAMPLE ANAILYS6 REMARKS <br /> / /� / <br /> TYPE/ / g /' TAT <br /> *VOCs: —Metals: <br /> dB�,e,�dP' � % �� ❑ 8280 List ❑ CAM17 <br /> ��� ❑ 8240 Lfst ❑ RCRA <br /> SAMPLE 10. DATE TIME sp �a dF �`� j®0� 0801 List ❑ LLIFT <br /> �Y b F+1" 'K" ❑ 624 List Y' <br /> .o IS VZ 'd1 <br /> b 'ti <br /> G Ifz <br /> ! IfiT•+1 <br /> i <br /> 6 <br /> i,. drL y <br /> rk. 1 lis <br /> M } <br /> L <br /> tr ) <br /> Aga- <br /> SAMPLE <br /> RECEI►T. CaoYr Temp: METHOD OF SHIPMENT RE JIPHBD Y: 1 RELINGUMMED BY: 2 RELINGURHED BY: B <br /> ❑Inlea ❑cad .. la�I�, <br /> ❑On lq 'OAmMenl GmIw,,No: LAB REPORT NO.: (S IDA ) (SIG 1 (DA NATURE) (DA <br /> FAX CDC CONFIRMATION TO: (PRINTED NAME) (TIME) (PRINTED NAME) (TIME) (PRINTED NAME) (TIME) <br /> PreNrvetive Correct? - � <br /> OYee ONO'ONIA COMPANY) tiYT (COMPANY) (COMPANY) <br /> ANALYTICAL LABORATORY: PAX RESULTS TO: RECEIVED BY: 1 RECEIVED BY: R REI B (LABORATORY): <br /> L <br /> SEND HARDCOPYTO: ISI - -(DA (S—IGwm U RE) (DATE) ( ) ( A <br /> OnZ �� G <br /> SEND EDD TO: (PRINTED NAME) (TaN (PRINTED NAME) (TIME) (PRINTED NAMES (nME) <br /> EMV.LABEDDS.COM L <br /> (COLI ) (COMPANY) (COMPANY) <br /> Shipping Copy(White) File Copy(Yellow) Field Copy(Pink) CHAIN o1 CUSTODY-ANALYSES FORM.CDR 512003 <br />