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low 'MW <br /> CON LANE AND ANALYSIS REOUEST�AD 20650 <br /> GTE L <br /> CONCORD, CA 94520 <br /> 415 685-7852 <br /> LAl04ATOa1ESN INC 800) 423-7143 (OUTSIDE CA) (800) 5443422 (INSIDE CA) <br /> Company Name Phone# 5 i p 971 -L3Y <br /> ` rr fl <br /> C't �r_.tnv-OG FAX# CDLu X <br /> a C] <br /> Company Address ClSite location (n ❑ ❑ ❑ ❑ © ❑ <br /> Protect Manager Client Project ID (#) ❑ ] y M - } [a a N <br /> �Zf39C� Z �� o o `n m m x o ❑ n °� <br /> LQ�,� �,. NAME S -� L 1V M U- ❑ ❑ ❑ ❑ z z p ❑ <br /> I attest that the proper field sampling Sampler Name(Print) TiVA A a ❑ o ' ❑ ❑ ❑ ❑ °' d ° ❑ <br /> O J J ? <br /> procedures were used during the collection � � �� ❑ G o p a N 0 0 cmi y ❑ a cn O a° <br /> of these Sam les <br /> o I.i m co U 'g' o $ p � civ a 0 D <br /> Method N - m a °° o m °° ❑ 7 o J ❑ <br /> Matrix Sampling �, p w a a m ❑ ❑ 0 0 <br /> Field GTEL a Preserved T N ❑ w Lu a$ J `2 m Q o <br /> ❑ E" °° ❑ ❑ ❑ ❑ R a. ° C] y w J <br /> Sample Lab # o ¢ �' ii d o fL <br /> ID (Lab use Only) , o z d w a w F W W m = m a a a aa.¢ a ►- < <br /> 3 uCi a En a p i i z v R, '< <br /> o m m i X O a w w w Loci w w UJ w w rv- W U mJ O U <br /> lE �, t <br /> B ti3 S l <br /> 2-a `� <br /> _-r z 1. 1 tieuse Ini ial , <br /> T W - s , to t a pl s to4d in i e <br /> l3 � r prorito otaEe <br /> All t <br /> a p E; re er e <br /> $ witho Alec d5qacl <br /> o rh n t <br /> I t � <br /> TAT Special Handling SPECIAL DETECTION LIMITS- RE <br /> Priority(24 hr) GTEL Contact <br /> E=xpedited�48 hr) Quote/Contract N <br /> 7 Business Days ❑ Contlrmatlon N <br /> Other pp# SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> i s <br /> Business Days E] <br /> OA/QC LEVEL <br /> BLUE❑ CLP❑ OTHER FAX❑ Work Order# <br /> ReUn wished by amp r ` ate , <br /> Time Received by <br /> R ulshed by <br /> CUSTODYDate Time Received by <br /> RECORDRelinquished by Date Timeeceive b rat <br /> ,moo <br /> n Waybill# <br />