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PRIMMOU WDM CKABI of USTODY igplINI <br /> Analytical Laboratory <br /> 3935 N.Coronado Ave,Stockton CA.95204 Phone:(209)477-8105 Page Of <br /> 1 1 <br /> Work Order No. 2010603Clia03 O i <br /> nt ame Project Name RequestedAnaryses EW Requirement RequesteelTurriAround <br /> UniFirst Corporation Effluent(1 per Week&2 per Wet Excel EDD <br /> Client Contact Project Number Geotracker Rush requests subject to <br /> William Geary UFC N DWQupload additional charge. <br /> Address Project Description <br /> 1O a QA/QC Rush requests subject to lab <br /> 819 N.Hunter Street O Regulator approval. <br /> QO <br /> City PO Number in in IV <br /> rr4 L9 State Specify: <br /> Stockton N o <br /> State/Zip Shipped By Ln Specify: Standard(days) <br /> CA,95205 Customer Drop-Off <br /> Phone Fax Matrix to = Global ID Expedited(days) <br /> .-i <br /> (209)941-8364/(209)941-4022 sediment Other N <br /> Sampler Sampler Signature Potable Soll❑ h `'-1 System ID Due Date <br /> nolan Leeo c0 wM <br /> Waste W Surface m O 2 <br /> _4 <br /> Preservation <br /> Sample Type Matrix Container laboratory Work Order No./ <br /> Laboratory Work Order No./ID Sampled Date Sampled Time Code Code Count b::l d::3 Sample Condition Temperature Sample ID <br /> Final Eff.Auto 24hrs Comp.Sampler 114 Q ;QV C W 1 1 0 O C. - 7 <br /> Final Effluent at Discharge Flume 61& if:00 G W 1 0 1Zi,1060 ,p <br /> Relinquished By Date�me Recei Date�me SAMPLING <br /> ZZ 2 Special Instruction <br /> Date/rime Received By Date/Tme COMPOSITE SAMPLER SETUP: <br /> Relinquished By Sampler(si <br /> Relinquished By Datefrme Received By Date/Time Date Setup rl <br /> 72 <br /> Cooler Numbers and Temperatures comment: Q <br /> Default Cooler at 5 2C <br /> Matrix codes: W=Waste water Preserv.Codes: 1=Store cool at VC,3=Add HCl to pHc2;Store cool at 4°C <br /> cont.codes b=500 mL Poly Unpres,d=1L Amber-FIC! <br /> Page 15 of 21 <br />