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,�..�_ ,r o <br /> (See Rev�erre for Instructions)T <br /> I <br /> PROJECT NAME 6 4 c MA Les -l��o sAup -ERS � �-• �-•s�l+r�rxs,r. $A�AP,LE CONTAIPIER SAMPLE p-SCRIPTiON CODES TAT DORES <br /> t lP pm DESCRIPTIOAJ CODES A. Gwnnt WaUr F. cu <br /> PROJECT NUMBER (A ��'�0� �cti*--• ��`1`j� A dQPel VOA Ym4 e.sur6d'Weser G tvs re a. S,rndamd <br /> 150GN} B.Glass Mur E. Brass Tu Ci a Laachm H.SIAM SPAY 2. 4 Ener � <br /> REE.ORDER G_ Prsuc WWO r-.4lher--_ a Flum"a a U1ber 3. 21 FEsor Cl1a <br /> (SIGN) <br /> D. PFastic Laec E- SoiY54CflnenA r_. <br /> NUMBER 1w ANALYSIS REQUESTED LABORATORY USE'OWH& <br /> PADCCNiAIMFRS <br /> o Fi <br /> .4 aERuaT10N _ <br /> 6p SAMPLE <br /> pit F 5 � NOTE5 AS&GNEA C�1�'tON <br /> E UPON <br /> DATE TIME SAMPLE ID ? <br /> idU EHS RECEIPT <br /> U • ., <br /> ILL <br /> i <br /> NOTES l MISCELLANEOUS relinquished by,(Signature) Aeoei By_(Signature) Date Time <br /> ��5` Buda r��j �iriyr 3....... Qj. Z -g <br /> b p& ffL4a-) Relingtrfahed 8y:{Sig re) 4LNeiired BY: riatu`a Dgllb Time <br /> Relinquished -('Signature) Received By:(Sig re) Gate ie. <br /> lubethad;ot 5hipJttern DescrEptian of Othpx Chains-Ot--Gustody Dispatched By:(Signature) Date Time Aeoeived for lab 8�(Signature) Dale Time <br /> TranWrt Container TiaQuIle ynll`t}iis <br /> Chain (by Soria)No.) <br /> Sendtab Results to(Name): (Cheek Office Below) Verbals Requested: Yes N© ❑ <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT. VIEW ❑ PORTER ❑ GTFIEti_}— <br /> TEL(�4fl4)9�ii 13065 TEL PW)790-1747 TEL(714)757-175.5 TEL(405)9601640 TEL P9)92&8651 Tfe t <br /> .: <br /> FItX I4fJ `95t!~936d FAX(3D0)799-01416 FAX(714)757-0960 FAX(415)960.0739 FAX Mg)824x7.169 <br /> 0 BCIE,mAN ❑ HOUMN ❑ KING OF PRUSSIA ❑ PLEASANTON ❑ PORTLAND ❑ arim" <br /> µ T 1(4-006) 5B0i9 as r-al 55-pa86 T 3 _. i TEL(5 4@W 17 TEk,6 "1,&' p2 YEL <br /> X556-]�t�6ili T <br /> IUs(215); FAX( T�)4043,2981 FAX-(,,, FAX <br /> CAN03�!lE ENVItTO4sIMENTAL SEWICES, CQAR • 6317l�°SO(1TF_Iw51f,HAG[1SE YUI4Y, Slit E 3�0• EttiIGiL 1NOOt}.CO°I30?111 +TELEPHONE(30)"29& • <br /> SKIMA NQ Q WHnE-.Field Caps YELLOPC Projed Copy - PERK:Lah"wi CW <br />