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4080 PIKE LANE, SUITE C r UU r Hk;L-UHV 26057 O C '7 <br /> CONCORD, CA 94520 i AND ANALYSIS REQUEST U J f <br /> (510) 685-7852 • , , fat <br /> EN YI A OHM E N IAI t' -t :- '� <br /> >• �AaoaAlaates. INc. (800} 423-7143 �,»�tITyE # ik r+ r .l.ti) Ali: ;s `" � <br /> ICompany Name: Phone#: _ <br /> FAX#: ❑GT 1 4) ( <br /> m ❑ <br /> Site location: w ❑�' '- _ <br /> Company Address: In <br /> Ccn L E- ❑ MCL 0 <br /> Pro'ect Manager: Client Project ID: O -�n /17 3 Ln 2 ❑ q <br /> U) rn = a a <br /> /� !VCr <br /> NAME L �~ M El ❑ 0 z z ❑ o ❑ p <br />'I attest that the proper field sampling Sampler)q (Prl t. 3 a ❑ o G7 ❑ o © 0 d g, <br /> procedures were used during the collection o N ❑ ❑ v "' o o <br /> lof these samples. ❑ o `" v © a g o a fL El N <br /> 8 8 ❑ ❑ o 8 <br /> Matrix Me ad Sampling Q Q o w a p ❑ a N ❑ <br /> Preserved a a ❑ <br /> Field GTEL ❑ W � © o ❑ 0. ao � ° J ❑ <br /> Sample Lab E W U N c� <br /> ID (Lab use on o W w w a m $ al <br /> o acc <br /> Ir <br /> a n '2 a a a a a a a 23 a <br /> 3 rr�i ¢ 91 N a 0 = x = V � iii�o m 0 = = o fL w w w w w w w w w r w <br /> 1 <br /> 111 <br /> IIU <br /> as <br /> tyl <br /> ' A� <br /> LV k <br /> W <br /> v <br /> LAE I I <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Priority(24 hr) ❑ GTEL Contact <br /> Expedited(48 hr) ❑ QuotelContract! <br /> 7 Business bays ❑ Confirmation 0other Co N SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location: <br /> PO <br /> Business Dae ❑ <br /> OA/QC LEVEL <br /> BLUE❑ CLP❑ OTHER FAX❑ Work Order# <br /> Ilnfished by Sampler: �j ate Time Received by: <br /> I L' �i <br /> CUSTODY Re inqulshed y: Date Time Received by: <br /> RECORD Relinquished by: Date Time KXved b%Laboratory: .47 <br /> 2Hov.7M �� 07&k4vyi-C_ �& <br /> Waybill# <br />