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APkM <br /> .,r <br /> ift-M ARI-N-0-Fol wy.A. 890,R. <br /> ;See Reirerse- it I�sliuctions) tU <br /> PROJECT NAME � �rt y/ MJ Lo��•.ra� SAMPLERS SAMPLE CONTawiNER SAMPLE CESCRIPTiON CODES TAT CODES <br /> tP pm DESCRIPTION C.DDES A.orauraWaEar C ai <br /> PRL)lEC7 NUMBER -�1 r ��r� -_ u► 1~ k 40.aJ vuw ural e- SurNer Waur G tvam [a. <br /> sra,dmw <br />�P JsDw} B. Glass tier E. Bra w Ube C LaraWhm R BIankABpr&9 4 ur <br /> I . RECORDER G. PftwcGO W F.41her_�_ D. Rarsseafa l COW 24 Hour <br />€ tSiGNi D_ Flarlic L Aar f_ saimeem"ari r_. <br /> NUMERCW ANALYSIS REQUESTED LABORATORY USE'OWY <br /> CCN TALUF.RS <br />?` U AND <br /> 2 <br /> S_ I fm <br />' �.: Efa1H5TaCSFr �� � �� <br /> �F SAMPLE <br /> NOTES ASS&GNED Cof4ll]CT�tom , <br /> 130 UPOnI <br /> DATE TIME SAMPLE ID <br /> ,1 r NUS RECEIPT <br /> tit_z g .sir b%- 16(4- W 0 <br /> a �= <br /> r - <br /> f <br /> NOTES IMISCELLANEOUS Relinquished by.(Signature) Received By-.(Signature) Date Tune <br /> hi <br /> rt1 OIr1r��..a�� f DA A Relinquished By:tS�B re) cei�d By:' grrature Date Tlr`ttl3 <br /> Relinquished :(Signature) Received By: (Sig w) Rale me <br /> Method of Shipment Deacriptlen of Cow Chnins-Cf-Custody Disga ached By:(SigrWtuffe) 1]ate Tirnaa Reouived for lab W.(Signature) Date Time <br /> Transom Container Transpbft vnlh this <br /> Chain(by Serial No.) <br /> Send Lab Results to(Name): {Check Office Bc#Lsw} Vert>als Requested: Yes Flo ❑ <br /> 3 <br /> ❑ ATMTA ❑ DFNVEf1 ❑ IRVINE ❑ Ml: VIEW ❑ PORTER ❑ OTHER <br /> 4 ; <br /> TEL 1404)951-0055 TEL PW)790-1747 TEL(714) 757-1755 TEL(415)960.1640 TEL(219)52&8651 T � <br /> FAX(404)9559384 FAit(SOLI)799-0136 FAX(714) 757-0900 r-AX(415)960-0739 FAX (219)82&7169 AX — H � <br /> ❑ SMEMAN D Ft7D11mm ❑ KING OF PRUSSIA CJ PLEASANTON CJ PORTLAND ❑ OTHER <br /> TEL;( X9496 TSL(7]3).,556 1666 E4 C� 37,2x51 TEL Cst1o) 4s3-s117 rEf� sa -0 � TEL . <br /> EA1t(4Q6)�5BS 72E FAX(713)5511 OS08 F,Z-N2IS} 7�5@Q FAX(610)463-29a1 FAX(5[1&3)241-0486 FAX <br /> _ . .. <br /> C-A,—A, SERVICES, CORP. • 63(10 SO(l 9VIRACUSE WAY. S11111E 340• ENGLEWOOD, CO`84111 • T'ELI P-TONE (3C3)2 '8336 • I <br /> SIMULL Na A Q Q WFIfTE:Mid Capt' YELLUvr.Pmpe Copy MK:tsaomml Cow <br /> 1 <br />