Laserfiche WebLink
ttttlt1;1K�� C�TODYILABQRATORY ANALYSES RE� OR <br /> FM <br /> a� <br /> S VoA txr F <br /> 2059 Junction Avenue•San Jose CA 95131• 408 437 2400•FAX 408 437 9356 SERVICE REQUEST NO P O <br /> PROJECT�� �"�–�UZ ANALYSIS RtEQLjr=STED PAGE OF ' <br /> PROJECT MGR �L.c_. PRESERVATIVE HCI HCI NP NP HCI HCI HNO NP SO H SO H SO NaOH <br /> COMPANY S� ccs " CO <br /> w <br /> ADDRESS IC50 K—WC� m`u uC a � <br /> t[ g <br /> v �, i 4 NO `�8z ZL LO U o 4u o 4� �°jo y e 0'* r m 1,, <br /> utid ea 1~ti 2O� �o�a m `V <br /> FAX `�� p m o`co � a q o` ry �u U <br /> SAMPLERS SIGNATU Cr C7%Lu <br /> SAMPLE LAB °o <br /> SAMPLE <br /> ID DATE TIME I D MATRIX z ,�C? _$ r`ap �4� mC� Qmro ►� O` ��' Q� Z�O�r°O a a <br /> 2 ti U REMARKS <br /> 7, k x s <br /> S A,(,Adt 3 <br /> x <br /> 7t <br /> RELI UI ED BY RECEIVED BY RELINQUISHED BY RECEIVED BY <br /> TURNAROUND REQUIREMENTS REPORT REQUIREMENTS <br /> a ureN Uj nature I Routine Report <br /> Signature Signature _ I day __._2 day—3 da <br /> �+- y _ II Report(includes MS <br /> �rinte Name anted Name Panted Name Printed Name — 5 day _Other MSD as required,maybe <br /> charged as samples♦ <br /> !40o Fum Firm Firm Standard(10 working days) III Dala Validation Report <br /> 6 {includes All Raw Data) <br /> Datelrrme DatelTime Date/Trme Results Due (includes <br /> A <br /> DatefTime — <br /> — Electronic Data Delnrerables <br /> RELINQUISHED BY RECEIVED BY SAMPLE RECEIPT Condition Custody Seals <br /> SPECIAL INSTRUCTlON5/COMMENTSL� � V <br /> Signature Signature � <br /> Panted Name .,,.'A <br /> Circlewhich met Is are tob analyzed p.im, r" -TAV�E }{p Lb 2Pr1k <br /> Printed Name Metals Al Sb Eta Ele 13 Cd Ca Cr Co Cu Fe Mg M?40'�N <br /> Firm Zn <br /> As Pb Se TI Hg (A aj� 7�2Z J <br /> Firm <br /> F <br /> e/Time Datelrime �-r.Ct�+rIt ed Via/Tracking 9 98 it Z015?—43 Storage <br /> DISTRIBUTION WHITE return to onginator YELLOW lab PINK retained by originator 4005 <br />