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GOE 4UtJU t-it,t LHIVLL, I t v AND ANALYSIS REQUEST'CONCORD CA 94520 <br /> (510) 685-7852YlNrAI (�00) 1 Ekl 1 <br /> tip «6aa><Won,Es. INC. 423-7'143 <br /> Company Name: Phone N: t eiis� 2qG- 7$ 7 - 4 <br /> i !� ❑ <br /> SAGO Q FAX N: C4+S1 G 7 . 9L�Ii( p r �: / C] ❑ <br /> Company Address: Site location: yu.-V+..1 —'6.�5 m ❑ ❑ o <br /> ?.o 2.9 ��� �n <br /> Cl) ca ❑ <br /> CQ Z <br /> LO t <br /> Project Manager. Client Project ID: (N) ❑ © (n � _ ❑ <br /> ,/► w O <br /> B1/'V[1t SC��/6rfv�t"1 NAME fr `cW��L� �d�S o_ ❑ 11 ❑ Cl z z ❑ ❑ ❑ ❑ ❑ <br /> vi <br /> I attest that the proper field sampling Sampler Name(Print): o ❑ o ❑ ❑ ` ❑ ❑ <br /> IL A m ¢ <br /> procedures were used during the collection Mo � � � ' N ❑ ❑ a � a <br /> of these samples. �Dh� W• r c ❑ a ❑ o- a a 13 o_ ❑ a ❑ ❑ <br /> Cn in <br /> o0 � 0.Matrix Method Sampling m ❑ <br /> a ❑ <br /> ° <br /> Preserved a IR w C <br /> L❑V <br /> ❑ <br /> `Field GTEL a 2 ❑ ❑ ❑ a <br /> Lab # <br /> Sample � ao <br /> W ¢ ¢ID (Lab use only) u w 0 w CL <br /> z W ww uw <br /> (0 (n a 0 12 x x x <br /> 0 .g <br /> a � <br /> IL <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS i <br /> Priority(24 hr) 11GTEL Contact <br /> Expedited(48 hr) ❑ QuotalContract N <br /> 7 Business Days ❑ Confirmation N <br /> SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot N 5loraLvLacation: <br /> Other PO A <br /> Business Days <br /> ❑ <br /> OA 1 GIC LEVEL 'Q <br /> BLUE❑ CLP❑ OTHERFAX❑ Work Order N <br /> Relinquished by Sampler: Date Time Received by: C 7� <br /> C" <br /> 7/1- Z j:10,0 f_... <br /> CUSTODY Relinquished by: Date Time Received by: - <br /> RECORDRelinquished by: Date Time Received by Laboratory: <br /> j : •�ta Wayb N <br /> W RsV.7101 <br />