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SAMPLE pAOJECT# 7JECOO <br /> DUE DATE PAOJMGR <br /> CHAIN OF CUSTODY 4f L a <br /> CLIENT I CONT A ANALYSES REQUESTED <br /> ADDRESS CITY STATE ZIP ti <br /> • Y <br /> u <br /> BILLING ADDRESS F O # ¢ <br /> PHONE# FAX PHONE SAMPLERPRIN-7Z tO T IGN NAME ,y A � / <br /> 75D/V JJ'[iAM" REMARKS SAMPLE# <br /> OMP w <br /> DATE TIME CONTAINER CLIENT or <br /> SA LED SAMPLED MATRIX AMOUNT PE PRESEAVATIVE SAMPLE DESCRIPTION/SITE LAB# GRAB ¢ <br /> ✓ O <br /> V <br /> MAI_ Z Uj <br /> w <br /> fw3 <br /> Uj <br /> w� <br /> 1/ a <br /> 1 a <br /> v ( "f� 7 u <br /> �V t > <br /> 2 <br /> r <br /> 10 <br /> a <br /> O <br /> o <br /> By submittal of sample(s),client agrees to abide by the Terms and Conditions set forth on the reverse of this document <br /> RE_INQUISH D BY D TEITI F, RECEIVED BY RELINQUISHED BY DATE/TIME RECEIVED BY <br /> ED <br /> J <br /> W <br /> F- <br /> R Ia -i5 <br /> SHIPPING METHODISHIPPING# RECEIVED BY DATEITIME CONDITION MATRIX AQ-Aqueous Nondnnkin9 Water Digested Metals <br /> TEMP SEALED YIN' INTACT' YM S Y FE„Low A L s Aqueous Nondnnking Water Digested Metals, <br /> 1 - - PR t DW-Dnnking-W41eT SL-Soil Sludge Solid AR-Air <br /> f <br /> ARKS' M <br /> FP=Free Product <br /> F CONTAINER TYPES AL-Amber Loter,AQL-250 mL <br /> AR Amber AHL- 500 mL Amber PT-P -'Istic) HG=Hall <br /> I# Gallon(Plastic) SJ=Soil Jar B4=4 i BT=Brass <br /> Tube VOA-40 mL VOA OTC=Othe, ontamer <br />