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—� � �� r wwwCA 94520 ■ffffl1N��US�QYRSD r <br /> FTVC CON PIK CORD NE AND ANALYSIS REQUEST <br /> CON <br /> r N V1 R 0NMI Ni AL 415 685-7852 ' <br /> tt' l <br /> ADO RAIORIIS INC 800 423-7143 OUTSIDE CA 800 544.3422 INSIDE CA <br /> Company Name Phone# <br /> FAX# ❑ e ❑ } <br /> Company Address Site location m _ �S El <br /> S-t 0(,�U �' ❑ ❑ ❑ cc O ❑ I* <br /> ❑ 4ail F <br /> Project Manager Cllenl Project!B (#y rU 3 d Z ` W 0 _ 0 a <br /> S atva r(A tiSC' NAME 5TH L, 9110 �I�OIi DN ❑ ❑ ❑ ❑ Co CO ❑ >� — " I <br /> i attest that the proper field sampling Sampler Name(Print) a ❑ a 0 ❑ ❑ c 0 0 <br /> procedures were used during the collection / (tA 0_r ❑ N N ❑ ❑ 0. a 0 O o <br /> of these sam les v I"' rV Q r a a a ❑ <br /> Method a chi d �' fA m a ❑ ❑ ° <br /> Matrix preserved Sampling W 0 a ❑ O w a 9O ❑ ❑ ❑ Q ❑ U 1 <br /> Field GTEL ❑ * ❑ ❑ W W 2 a � � �a � y � ❑ � ❑ <br /> Sample Lab # "' a ❑ N ❑ x a <br /> ID (Lab use only) fL _� pp o ru o o w w Q o b <br /> Cr U Z �n¢ i i p� A a a a a a a a a U as `cru° E' qq <br /> 3 N a rn d p x X x U 01P O F ca [A x x 0 F- W W W W W W W W W I- W U r O U <br /> F1 I - <br /> + 1 X <br /> D ra 2 <br /> 0 U'-i <br /> 1 2 cl ZTz- <br /> o Z <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Pnonty(24 hr) ❑ QTEL Conlact <br /> Expedued(49 hr) ❑ OuotalContracl I <br /> i` <br /> B <br /> 7 usiness Days ❑ Confirmation I <br /> 7 Bu p0 I SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> Business Days <br /> QA 1 OC LEVEL <br /> BLUE❑ CLP❑ OTHER FAX❑ Work Order# <br /> Relinq y ler Date Time Received by <br /> X212$ <br /> C, E��O D� <br /> RURelln hed by Date Time Received by ^ <br /> E C O R D Relinquished by Date Time Received by Laboratory `, <br />