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MW OF CQSTODY ignp <br /> Analytical Laboratory <br /> 3935 N.Coronado Ave,Stockton CA.95204 Phone:(209)477-9105 Page of <br /> 1 1 <br /> Work Order No. 2012103 <br /> ClientName Project Name Requested Anal-ieas EDD Requirement Requested urn Around <br /> UniFirst Corporation Effluent(1 per Week&2 per We Excel EDD <br /> Client Contact Project Number Geotracker subject us <br /> Rh re to <br /> ❑ q <br /> William Geary UFC DWOupload ❑ additional charge. <br /> Address Project Description <br /> QA/QC Rush requests subject to lab <br /> 819 N.Hunter Street O Regulator approval. <br /> City PO Number in <br /> Stockton tV State Specify: <br /> N <br /> State/Zip Shipped By h Specify: Standard(days) <br /> CA,95205 lG <br /> Phone Fax Matrie 00 Global ID Expedited(days) <br /> (209)941-8364/(209)941-4022 sediment other❑ <br /> Sampler Sam pl Sign ure Potable soil❑ System ID Due Date <br /> O <br /> �I��yLtn �� rte W Surface❑ 00 <br /> reservation <br /> Sample Type Matrix Container laboratory Work Order No./ <br /> Laboratory Work Order No./ID sa led ate Sampled <br /> st Time Code Code count a:J Sample Condition Temperature Sample ID <br /> Automatic 24 hrs Composite Sampler Ll (/ C W 1 1 <br /> Relinquished By / Datelr Rert,w y Dat — / _SAMPLING <br /> Z I I ZZ <br /> Special Instruction <br /> Date/rime Received.y atetrime COMPOSITE SAMPLER SETUP: <br /> Relinquished By Sampler(s) <br /> Relinquished By Datetfime Received By DateRme Date Setup <br /> Cooler Numbers and Temperatures comment <br /> Matrix Codes- W=Waste Water Preserv.Codes: 1=Store cool at 4'C <br /> cont.Codes a=1L Poly-Unpres <br /> Page 19 of 21 <br />