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73^1^Lab No <br />Analysis Request TEMP °C <br />Bnull iddress: <br />UkiahProject No: <br />Address: <br />LivermorePONumben <br />Phonc/Fax: <br />Elk Grove <br />Container Prosorvative Matrix Petaluma <br />days <br />Carlsbad <br />Sample Identification <br />1XXX <br />X 1XX X <br />Received by Date Q Yes O No <br />ON0 <br />L_(g <br />iMsc Supplies: <br /><D•s o o x <br />cJO 3 £ o <br />Chain of Custody - Work Order <br />Reports and Invoices-delivered by email In PDF formal <br />o <br />co <br />O z <br />X <br /><D x: <br />O <br />£ <br />1 > <u <br /><D <br />CO <br />O OT <br />CM <br />X <br />Standard <br />10 days <br />® <br />s <br />a <br />To f <br />o <br />co <br />5 O <br />z <br />ffl <br />ro <br />> <br />U <br />RUSH: <br />5 days <br />48 hours o <br />Other <br />I <br />IDate <br />Sampling <br />Time <br />B p-eHier E4 <br />Ac&mpu, ca qszzo <br />WphnTAhWytiaif LnboraUirics Inc. <br />■www>dpha-labg.com <br />Waters, Seoimewts, Souds <br />E <br />I <br />o <br />d <br />X <br />Time <br />1555 <br />Pg of <br />Signature below authorizes worfr u'nder terms stated on reveres sldhT'" <br />TAT <br />Relinquished by <br />DDW Write On EOT Transmission? <br />State System Number <br />i -if "Y" please enter the Source Nurhberfs) in the column above <br />CA Geotracker EOF Report? O Yes <br />G,[>&81 ID: SampHna Company Log Code: <br />EOF loXEmaa Address): <br />Havel and SUe Time; <br />S <br />g sI <br />Corporate Laboratory (1551) <br />208 Mason Street, Ukiah CA 95482 <br />cfientservf6es@alpha-labs.cofn <br />North Bay Laboratory (2303) <br />tlO.Llberty Street, Petaluma CA 94852 <br />Invoice to (if different) <br />Conuct-. <br />§ <br />I <br />I <br />Preapproval <br />required <br />Notes I DDW Source Codes <br />Bay AreaLaboratory (2728) <br />SflZRjckpnbacfcer,Circle;.Livermore CA 94551 <br />Central Valley Laboratory (2922) <br />:808b Urilon Park'Way# 113, Elk Grove GA 85624 <br />San Diego Laboratory (3065) <br />2722 Lbker Ave West. Ste A, Carlsbad CA 920'10 <br />" Projectlnformation <br />ProjectID: =— <br />Report to <br />s wt Demand <br />Attn: ’ <br />Norw fcrreira <br />litis s peHu-r M <br />Acampo, ca <br />Phonc/Fax: <br />Email Address: <br />Field Sampler Printed Name & Signature: