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BLAINE 1580 ROGERS AVENUE 1�CONDUCT ANALYSIS TO DETECT LAB Sequoia DHS# <br /> SAN JOSE,CALIFORNIA 95172-1145 ALL ANALYSES MUST MEET SPECIFICATIONS AND DETECTION <br /> FAX(408)573-7771 <br /> TECH SERVICES,INC PHONE(408)573-0555 LIMITS SET BY CALIFORNIA DHS AND <br /> W ❑ EPA ❑ RWQC <br /> ❑ LIA <br /> CHAIN OF ��$,&q" ,� ❑ OTHER <br /> CLIENT O SPECIAL INSTRUCTIONS <br /> E uiva- Karen Pe a Q ,�,� <br /> SITE 440 W Charter WayU' Send invoice to Eguiva <br /> Stockton, CA Q H 00, incident# 88870583 <br /> r O000 a, Send report to Blaine Tech Services, Inc <br /> MATRIX CONTAINERS 0 IV <br /> 2 ATTN Am Pember <br /> H H <br /> Sh <br /> `� o <br /> SAMPLE I D DATE I TIME m 37� 7 <br /> TOTAL U Fy r H O ADD'L INFORMATION STATUS CONDITION LAB SAMPLE# <br /> ►� I 11xxipl <br /> y4 Z qt y MY11 <br /> �1 II X A �3 <br /> Mw�y jug X, 11 <br /> is-so V/ . .XIX11 x xos <br /> r�w_6 oftli ,"/ I , lix 11 <br /> Boz vJ !I 11 c� e- <br /> w r9 z3s vJ T <br /> S MPLWG JDATE ITIME SAMPLING RESULTS NEEDED <br /> COMPLETED - PERFORMED BY Gam/ 57 ,y ,i� NO LATER THAN <br /> RELEASED BY ::JDAT 11 TIME RECEIVED DATE TIME <br /> Fav 2 'b oo �r5 <br /> REL BY DATE I ITI E �RECEIV D BY E TIME <br /> RELE4SED BY TEI IME RECEIVED BY JDATE TIME <br /> SHIPPED VIA DATE SENT TIME SENT COOLER# <br />