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408077E LANE, SUITE C CHAIN-OF-CUSTQDY RECORD 25992 <br /> CONCORD, CA 94520 AND ANAL YSIS REQUEST <br /> I N V r R O N M I N r A t (510) 685-7852 .,. <br /> LARORA 0211f INC � <br /> ltlttttt� (8001 423-7143 �a .L s <br /> Company Name Phone# s 555 r J <br /> FAX# <br /> Company Address Site location d ❑it ❑ <br /> yds PoT 664 4 w �bGk�'Dr� '� ❑ ❑ ° U ❑ <br /> Protect ManagerClient Project ID (#) O Z 03�Zi t ❑ u a ❑ ❑ s <br /> C v t J <br /> J �^ l-lNdS� NAME S�� L (� o❑ a n m = o ~ n ¢ <br /> ortaa ro ❑ N ❑ ❑ zz ❑ � ° ❑ <br /> I attest That the proper field sampling Sampler Name(Print) ❑ � �, ❑ <br /> procedures were used during the collection q v ❑ A, ❑ o � � � � � v N ❑ <br /> of these samples rC ! !J�� ❑ a a ❑ o `4 ❑ a p -6 y a <br /> Method S �' CO m o p N ❑ o ❑ I. H <br /> Matrix Preserved Sampling co g v ❑ o a a °° ❑ � c b <br /> Field GTEL u C � ❑ ❑ ►°ra le -J o 2 'A L <br /> Sample Lab # W e, N � � ,- ❑ 0 0 0. 0- ❑ y <br /> ID (Lab use only) < � o � � o �, 9 g 9- 8 � � Xcn <br /> R <br /> a <br /> wr- _ m a a 4 ¢ Q a a a g <br /> uDi a ren a o a = z oN o m co z 3 w w s i u°i w w u�i w IU- u4r C�7 0 U <br /> r 1 bI 4 �yz <br /> W — l$ � r✓ Z <br /> Mw--Ro1 � <br /> Mw - ISA <br /> MW - 19A PS uX oak �. <br /> W3Mw <br /> MN <br /> 05emn <br /> z <br /> R13 Mv, - 1 e <br /> I I I JL:i7\- I I 1 -1- 1 1 <br /> TAT Special Handling SPECIAL DETECTION LIMITS C REMARKS <br /> s; ti <br /> Priority(24 hr) ❑ QTEL Contact <br /> Expedlled(48 hr) ❑ Ouote/Contract# � <br /> 7 Business Das <br /> Y Confirmation N <br /> Other PO# SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> Buslness Das ❑ <br /> OA/OC LEVEL <br /> BLUE❑ CLP❑ OTHER FAX❑ <br /> ReliWork Order# <br /> n i had Sampler Date Time Received by <br /> CUSTODY Relinquished by Dale Time Received by <br /> RECORD Relinquished by Date Time Received by Laboratory c <br />