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3 mach Analytical Labs, i34 Victor Court (408) 588-020D0 <br /> 3Chain of Custody / Analysis Request <br /> 33 <br /> Santa Clara- CA 95054 (408) 588-0201 - Fax <br /> Attention lo: Phone No.: Purchase Order No(Recid): Send Imolce to fit Different) Phone <br /> ��`l <br /> Company Name: Fax No.: Project Number: Company <br /> rev, ISl o(,S03 <br /> Mailing Atltlress: email Project Name: Billing Address (tt Dilferenl) <br /> City: Sl/ate//:�� Zp: Project'�Location: City: Slate Zip <br /> Sampler. Feld Org.Code: Turn Around Time <br /> ❑ Same Day [:11 Day m�e p aa0 <br /> 2Day ❑ 3 Day mom c;° v <br /> Global l0: C] 4 Day ❑ 5 Day mm O m a2 QA A°° s C <br /> ❑ Standard (10 Day) F"„m m0 a° °" p ` <br /> Order ID: Sampling _ w '6 ? <br /> ° <br /> m a C w <br /> ° ` ° w>v Cr <br /> 0 7U aClient IDField PT Lab- No- xt Zell, r ci r �ryr <br /> raO 5Date Time <br /> v <br /> Remarks <br /> SIG 038 � .SO <br /> _ ---(- <br /> 1�Gn <br /> < a tinea by:`\1 R atiea brf n t Wn., r T• Special Instructions or Comments ❑ NPDES Detection Limits <br /> tr <br /> Pei. ei:ma . Date:rDate: rm<: - ❑ EDD Report Required <br /> 40 h;cK ❑ EDF Report Required <br /> Ftcli Ou'sM1ed h . Re d bg now Time: Metals: ❑ PDF File Required <br /> At,As, Sb, Ba, Be, B, Cd,Ca, Cr, Co,Cu, Fe, Pb, Mg, Mn, Hg, Mo, Ni, K, Si, Ag, Na, Se, Sr, <br /> Re4naoen<a hv: Reeemea br. TI, Sn, Ti, V, Zn, W : RCRA-8 ❑ CAM-17❑ Plating 0 PPM-13 ❑ LUFT-5 ❑ <br />