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Ctain-Of-Cust ' Record and Analytic Instrlictio ns fate - of B00079 <br /> -. .____.il�a�ea •:tea �• : ,:. : , ,, . . °� <br /> Send'a"t�llres its and invoices to: <br /> Field I og 3tA,11 (t�(wii) -� L----___. w1c <br /> N1. Heaton, <br /> _ _ _/ <br /> (please fill in and circle) 1_L_NL :1rcl. It-_.���t�' _ Santpliilp Re(luestll <br /> ---- — <br /> L <br /> Attn: ORAL) Data Management Team L-633 Analytical I ah(,rat(rry Name c S <br /> awience Livermore National Laboratory \nal)tical I ;Ih salol Y Log ll_ I s GSZ <br /> -- <br /> P.O. Box 808, Livermore,CA 94550 - - <br /> :AnAysis & I tirnmotlntl ;�Jdiritm;tl""I's <br /> Also Fax copies to: � VI ax # S/z 2 ?Y Requiredhoicc( Name:Sam ,legl I3 �,..I Y Sarnplcr's f;nil,loycr. v) <br /> Sample NLuriv'I> z( sample I #o' Study `� c�Identification Zzt- <br /> Date/Time ('onlainrt�fypc 3 Cont :1:ca �/ I jfL-) - RCltV-0I,63' -U( L(I- So- , �� — <br /> '— – - ---- <br /> fi x)A p <br /> ------ --- -- - b t orr r) <br /> nature Cum,am Ti ru Date <br /> I normal fill 11: o(, I-wce a narot <br /> r <br /> Rclinyui>hrd 71, <br /> •{l�+ � C�Z—r'Y �%- �o� 7 �R>--. t hour lurnatuun(I. tt = I loltl donot an;tl��r unlc��rn1lic�/�tl `/ <br /> Received by - _ 2 S,intple Nfalrix Codes See list on back of pink cop, <br /> Relinquished by !100 i, t nniainer type co(les: %' = VOA Boule, P=Plastic IIuItIe.�G// R{ <br /> Received byG Mao <br /> =Glass Botlle,'I'= Brass tube, J <br /> 7 It= Bag,S=Stainless Steell uhe. <br /> Rclinduishc(I by <br /> O=Other(specify under remmks) <br /> Receis ed hp - —�— Inlrrnal ll c r lnl7 <br /> While:Laboratory return to -- ---- <br /> hc�i�im i t y l ello,c': Anal Ileal t;J, Pink:Sampler leaves��ilh ORAD � <br /> Alin.Data Management Team L-633 y Alin.ORAD Data Ntanagemeol Team L-633 <br />