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Client name Project or POI Anstysea required <br /> Address Phone I <br /> .� by W.E.S.T. <br /> CI1y,Slate Zip Fl�pon attention <br /> — r - - - ------ - - - .0 - - ---- - <br /> tr .www ,_�. .. ._.—.,. ... � �Vcq da18 <br /> Sampled <br /> LabType L� �+1� Number <br /> Sample Date Time See key C�l CSC( of \( p <br /> number sampled sampled below Sample description conlainers �U y� Remarks <br /> r <br /> C--ji►�`r� �'� r Co <br /> 3C51 <br /> -k 1 <br /> Signature Print Name Company Date Time <br /> Retinquis td:�=A, <br /> Received by +1 <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received by Laboratory � r <br /> B C ANALYTICAL Note:Samples are discarded 30 days after resulls~are reported unless other arrangements are made. 'KEY: WW—Wastewater SU—Surlace Water SO—S: <br /> ❑ 1255 Powell Street.Emeryville.CA 94608 (510)428.2300 <br /> Hazardous samples will be returned to client or disposed of at client's expense. SL—Sludge PE—Petroleum OT--Other <br /> 0 801 Western Avenue.Glendale.CA 91201 {BSS}247.5737 Disposal arrangements: NA—Nonaqueous GW—Gsoundwaler AO—Ac <br />