Laserfiche WebLink
i jWT CONCORD, CA 94520 I AND ANALYSIS REQUEST L U U J O <br /> IHVIRoHMrktAL (510) 685-7852 <br /> LAIORAIORIEI, INC. (800) 423-7149 - t' ' '� I" I,�i' • 'V + <br /> CompApy Name: Phone <br /> FAX#: ❑ ❑ <br /> Company Address: Site location: LU x ❑ <br /> ❑ 0 <br /> Project Manager: Client Protect I V) D ❑ ❑ ❑ ❑ Z <br /> Q2ombzf 02aso �_ 15 <br /> n NAME 4- - . N o ❑ ❑ ❑ ❑ z `zz' 13 0 0 n <br /> I attest that the proper field sampling Sampler Name(Print): ❑ _N c ❑ ❑ 'E ❑Ej ❑ ❑ <br /> procedures were used during the collection ., ❑ � ❑ ° m ¢ -J cg'i ca 2 <br /> of!hese samples. N ❑ o q _o ❑ ❑ a <br /> Method ren a ❑ �! ❑ a o ❑ y <br /> L) Matrix Sampling Q o a s o ❑ v <br /> Field GTEL � Preserved ❑ IL o ❑ o w w ❑ ❑ ❑ o ❑ <br /> Sample Lab # w $ ° ° ° � 0 ❑ N ° <br /> o ¢ try ¢ c7 o m rn <br /> ID (Lab use only) J a o Lil q W� �, w a �, o .4 <br /> a O � ¢ U Z V g �y Q a q a na a 4 a a 0. a U a ¢ rn t= <br /> K 3 rn `a 0 a o x x x _ _; o o F m m x = 'o w w w w W w t11 w w r W v <br /> J <br /> w <br /> 1 <br /> mmyj <br /> Lng <br /> MINH <br /> TAT Special Handling SPECIAL ETEC ON LIMITS REMARKS <br /> Priority(24 hr) ❑ GTEL Contact <br /> 2 <br /> Expedited(48 hr) ❑ Quote/Contract M <br /> 7 Business Days ❑ Confirmatlon N <br /> other PO# SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location: <br /> i Business Das ❑ <br /> QA 1 QC LEVEL <br /> BLUE❑ CLP❑ OTHER 1 FAX❑ Work Order N <br /> y:CUSRelinq i 3by S pier: Date Time Received by.- <br /> CUSTODY <br /> TODY Relinquished by: Dater Time Received by: <br /> RECORD Relinquished by: Dat Time Race Labdralory: <br /> Rev.7191 Waybill# <br />