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AND ANALYSIS REQUEST <br /> TO L <br /> CONCORp, CA 94520 <br /> tNYlAONMfNrAi 510 685-7852 { <br /> } <br /> ® IARORA►oRlf3, INC. 800 423-7143 "s.. . �'` <br /> Camp Name: Phone N: 0 <br /> ` FAX#: ❑ m ❑ <br /> 1 <br /> Company Address: Site location: !`! _ g 13 <br /> g ❑ ❑ ❑ ¢ $ <br /> ri .. 0. 0 ❑ <br /> Project Manager: J Client Project ID: ( PG7-Q� y1 o <br /> d ❑ Q <br /> NAME `,- �.l rtj �A�1 1.1'1 o ❑ ❑ z z ❑ ? ❑ p <br /> I a est that the proper field sampling Sampler Name(Print): a o ° ❑ 9 v A lit <br /> m a <br /> procedures were used during the collection n c� ❑ § a ❑ ❑ ❑ <br /> of these sam les. +"� L ❑ c ~' — o_ ❑ <br /> Method S ri 2 a g g ° % ° 8 . <br /> c Matrix Preserved Sampling cs a ❑ o o a. 0 0 ❑ ❑ o. o ❑ <br /> Field GTEL ❑ �; <br /> Sample Lab # Ir 0 'D cc o <br /> Lab use only) c o d W ►- h <br /> ID iJ -� m e a a a a t g <br /> y� <br /> cc v z v �y a 1y — o a a a a ¢ CL n a v a. <br /> v� ¢ -J o. m m x O u.I W W W W W W W u.! ►- w <br /> -3 <br /> IYluf - <br /> w - <br /> w- <br /> w � - <br /> IMw... <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS 7b5 s TI,,d`�_S�1O�t�i1! Se�I <br /> Prlorlty(24 hr) ❑ GTEL Contact <br /> Expedited(49 h►) ❑ QuolelContract N <br /> 7 Business Days ❑ Confirmation N <br /> SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot N Storage Location: <br /> Other PO 1' <br /> Business Das ❑ <br /> OA I QC LEVEL <br /> BLUE❑ CLP❑ OTHER FAX❑ Work Order N <br /> Iinqu shed by Sampler: Da, <br /> Time Recelved by: <br /> CUSTODY sh d by. Datb Time Received by: <br /> RECORD Relinquished by., nale Time RKod by Laboratory: <br /> t <br /> Rev.1101 Waybill N <br /> �— •.----� <br />