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�► SAFE CUSTODY —� �O s- <br /> L • ' • ' CLIENT l !� ��+ CO T NAME ! 1 f JPHONE# <br /> +(C_/j kf 3 bq 34 <br /> Water& Hazardous Waste ADDRESS CITY STATE ZIP PAOJ MGR <br /> Sampling, Analysts, & Consultation <br /> t 1885 N KELLY ROADNAPA, CA 44558 BELLING ADDRESS PO # FAX PHONE <br /> (707)258-4000L. Ix (707) 226-1001 <br /> r PROJECT# P CT AM SAMPLER(PRINT&SIGN NAME} �� ANALYSES R E Q U E S T E DUE DATE <br /> LAB# COMP <br /> DATE TIME _&ONTAINER {Nan or CALTEST <br /> ' SAMPLED SAMPLED MATR MOUNTI"rYPE PRESERVATIVE SAMPLEOESCRIPTION/SITE Caltesi GRAB MARKS LAB# <br /> i <br /> �V�q 130S <br /> M Ki—lie J ! ' Z <br /> lZtd Mme — � �c� i�^*•t � - 3 <br /> r <br /> ltiG� v ty G 1v nlr ( o&c-�� - s <br /> 14L I <br /> It <br /> RELINQUISHED BY / DTE IME rRECEIVED BY RELINQUISHED BY DATEITIME RECEIVED BYj/I;a11N_ <br /> SHIPPING METHOD SHIPPING# RECEIVED Y DATE/TIME CONDITION CONTAINER TYPES MATRIX <br /> AL = AMBER LITER AQ = Nondnnking Water <br /> J 6 COL Y SEALE IN INTAC !N AOL = 250 ml AMBER Drgested Metals <br /> WZ AHL = 500 mi AMBER WW= Waslewaters <br /> REMARKS f Pt = Pint(Plastic) Non Digested Metals <br /> U) V HG = Half Gallon(Plastic) FE = Low DLS Final Effluent <br /> Z) SJ = Sod Jar DW = Drinking Water <br /> 4 Q { 1 B4 = 4 oz BACT SL = Soit/Sludge/Solid <br /> u J <br /> s BT = Brass Tube AR = Air <br /> 0 VOA= VOA(40 mi y IW = lrnga ler <br /> OTC= Other Type Container Non Metals <br />