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q SUBM #- 9501124 <br /> CLIENT: CH2 <br /> CIf H/LL DUE: 0117/95 <br /> QUALITY ALABORATORIES 'AFF '20I1 <br /> NALYTICAL TO.PERFORM SERVICES 2 <br /> CH2M HILL Project* Purchase Order# <br /> (� <br /> ,^� 1 A sHAbEb.AREA-.FOR LAB,USE ONLY,,:, <br /> B A;E,22 Lb V� .Ag.u Lob 10 Lib 24 <br /> Project Name s <br /> b6 alhA 1123Z> # = <br /> Company Name1CH2M HILL Office I Giiote* ! r <br /> n 1 O <br /> ' t1� F y: <br /> r <br /> Pro eANALYSES REQUESTED <br /> ct Manager b Phone# Report Copy to: P�� # <br /> Ms."r ]` ply I I a ' <br /> r� i <br /> Dr. '�w'G O I ; <br /> Rquested Completion Date: Sampling Requirements Sample Disposal: N I No•"�Sttntpl # i;. Pale' of e <br /> t C ' Dispose Return T <br /> ��f 'S ( SDWA MPDES RCRA 07HER P A �1 I <br /> r �cuVL ❑ ❑ ❑ ❑ <br /> N i GOC Rev LopFn LiL18 Ver Ack Gwi <br /> Type Matrix E E <br /> Sampling C i G W SR <br /> CLIENT SAMPLE ID t <br /> 0, R A OS <br /> M A T F (9 CHARACTERS) 1 ' <br /> l <br /> Date Time P B q L REMARKS 1 1 , <br /> I <br /> i <br /> pled By&719 (Please a and Plot ( teMme i Relinquished By ( sign and P no Meme AP!LApINESgA. Y 1V MAt <br /> Rved B (P glgn ww P ) C Date a Relin uished B ease sign a p t na <br /> REQ q Y :DatelTime Leval: 1 2 .3 Other: <br /> nj 1 ate° COC Ree . ICE <br /> Received By (Pease sign and Print awns) DateMme Relinquished By (Pkese sign end Pam names DateMme An t�eq TEMP <br /> Cuss Seel lPh <br /> Received By (Please sign end prim cams) DateMme Shipped Via Shipping# <br /> UPS BUS FedEx Hand Other <br /> Work Authorized By (Please sign and pant name) Remarks <br /> Instructions a--'A-yreement Provisions on Reverse Side _ _ _ — _ ORICIAW-Lap $:, ' 4 Mk_Lys �. <br /> AL._; JRM <br />