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10500 UNIVERSITY CENTER DRIVE AND ANALYSIS REQUESTORD 2 EL n 3 8 8 <br /> TAMPA, FL 33612 r} <br /> � L� ORATORIESN INC AL (813) 979-9092 r+J y <br /> ompany Name Phone# <br /> 1 FAX# ❑ <br /> Qmpany Address Site location *� ° _ ❑ <br /> 2 1v 1r �� ,L 2 �' ❑ ❑ ❑ a ° cr 8 � <br /> S oifi C�11CA W = ❑c � ❑ ❑ <br /> rotect Manager Client Project ID (#) � 2 a m ❑ w t z <br /> 1� S LiC� J NAME C3 g ❑ © ❑ ❑ Z z ❑ ° fJ <br /> O <br /> attest that the proper field sampling Sampler Name(Print) _ 0 o �+ © S ❑ o 9 J RV <br /> rocedures were used Burin the collection v, eo g `r M ? a m ¢ ¢ s 0 <br /> g �� L ° c G7 ❑ N °o aU o ❑ a U ❑ s r <br /> f these samples 1�' 1 l S o r a R a p r- <br /> Method N 0 m a Ln 10 CO ❑ co m ❑ o U g <br /> E Matrix Sampling � 0 o a a a a C, ❑ ❑ ❑ a G " ❑ <br /> Preserved a d ❑ W a w a <br /> Field GTEL ;v = = _ r ❑ ❑ W W a a CO � �, �, ❑ ❑ <br /> Sample Lab # ~ ° �, 1; ` � - ❑ ❑ ❑ a ❑ <br /> o x oC N L3 `��° a g -0 0 S co W � Q N c H <br /> !D (Lab use only) W p o W o Uu W o a �_ <br /> o x d cn w ti :,:Lu r W ui - v `O = m ¢ ¢ ¢ ¢CL 0- ¢ a ¢ J ¢ CO tq <br /> ON Q U) 1L 0 2 2 2 U ON O F- m m 2 z 0 4-- w W W W W W W W W FCL CLV- til U J O C7 <br /> 11 . <br /> _ 1V0 <br /> r <br /> w ` i <br /> r � <br /> W <br /> TAT Special Handling' SPECIAL DETECTION LIMITS REMARKS <br /> Prionty(24 hr) ❑ GTEL Contact <br /> Expedited(48 hr) ❑ Quote/Contract# <br /> T Business Days ❑ Confirmation# <br /> SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> Other PO# <br /> 3usiness Das Sr., � �- <br /> QA I QC LEVEL f i o 0 p <br /> 3LUE❑ CLP❑ OTHER `4 + FAX❑ Work Order# rf1 <br /> Relin is ed byS I Date Time Received by <br /> 5i I ' PAP, <br /> CUSTODY Relin fished 4 Date Time Received by <br /> RECORD ` Rehn i hed by Date Time Received by Laboratory <br /> Waybill # <br /> I ire t Y <br />