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I <br /> • GROUND WATER SAMPLING AND <br /> ANALYSIS REQUEST 1]s4tqi;- <br /> PROJECT MGR. F)4- <br /> AUTHORIZATION <br /> PROJECT N..E rzfi llD <br /> PROJECT NO. <br /> DATE SUBMIT7E:, ! 112-3195- <br /> Utz PM/GEOLOGiST <br /> r 2-3 95- <br /> PM/GEOLOGIST k• DUKE <br /> Emcon SPECIAL INSTRUCTIONS / CONSIOERATICyS (well eccass, time fraena I <br /> ��x�,c;u` 1�vR•tL"� & T [,,,�PTJ l r-Re� Al P,�a7 <br /> SQA-✓•4C �YA"�3ri <br /> WELL LOCK <br /> NUMBER <br /> ❑ CHECK BOX TO AUTHORIZE DATA ENTRY <br /> WELL NO. CASING CASu,G 08" <br /> OR SOURCE DIAMETERLENGTH TO WATER • ANALYSES REQUESTED <br /> UrF�ur`,�T N►q N A N i <br /> FCvt�I�T <br /> NOTE IT IS VERY IMPORTANT TO INCLUDE A COPY OF PROJECT PROPOSAL <br /> AND A WELL LOCATION MAP OR SKETCH WITH THIS REQUEST. <br />