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Client name Project or PON Analyses required <br /> 13 t2r-1 tj Z 0,5 WED <br /> Address Phone 0 LL <br /> X.S.T. <br /> city,Slat Zip----__, <br /> -7= <br /> Lab Type, Number <br /> ' <br /> Sample Date Time See key ol <br /> number sampled sampled below Sample description containers 2 5 Remarks <br /> -rcz I <br /> LZ3 402�&a- <br /> --rci-p <br /> -r-C4,P- <br /> Signature Print Name Company Date Tim <br /> Received by <br /> Relinquished by <br /> Received by <br /> Relinqk4ishad <br /> Received by Laboratory <br /> 8 C ANALYTICAL Note:Samples are discarded 30 days after results are reported unless other arrangements are made. 'KEY: WW—Waslewalof SU—Surtace Water SO <br /> Hazardous samples will be returned to client or disposed of at client's expense. SL—Sludge PE—Petroleum OT--Other <br /> 0 1255 Powell Street,Emeryville.CA 94608 (510)428-2300 Disposal arrangements: <br /> GW—Groundwater AC�-- <br /> 0 801 Western Avenue,Glendale,CA 91201 (818)247-5737 <br />