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Ir <br /> P ` of <br /> NORTH COAST <br /> LABORATORIES LTD. Chain of Custody <br /> 5680 West End Road • Arcata • CA 95521.9202 <br /> 707-822-4649 Fax 707-822-6831 <br /> LABORATORY NUMBER: <br /> Attention: _ J.14)d ,9_r_e.4a w TATO STD(2-3 Wk) ❑Other: <br /> Results& Invoice to: <br /> PRIOR AUTHORIZATION IS REQUIRED FOR <br /> �� � s�c.d f� "'�� ? <br /> --1jir---s— � <br /> Address; YIZ RUSH SAMPLES. <br /> W K/i4/S e� <br /> REPORTING REQUIREMENTS: /► <br /> Phone:_ 7a? — Y�l/ — SSS' El State Forms <br /> Copies of Report to, �Geotracker ❑SWAMP ❑ Other EDD: <br /> ❑ Final Report PDF ❑ FAX By: <br /> Sampler(Sign&Print): CONTAINER CODES: 1- h gal.pl;2-250 mi pl; <br /> 3-500 ml pl;4-1 L Nalgene;5--250 ml BG; <br /> - 6-500 ml BG;7-1 L BG; 8-40 ml VOA; <br /> Project Number: 00 7/SZ 9--60 ml VOA; 1025 ml VOA;11-4 oz glass jar; <br /> Project Name: DtL dx.. S'p,Ej p,( j 12-8 oz glass jar; 13—brass tube. 14—other <br /> Purchase Order Number: PRESERVATIVE CODES:a—HNO,;b--HCI;c—HSo - <br /> d—Na25,03,a—NaOH;f---C2H30ZCI;g—other Z <br /> 41 <br /> M 16 rp /4�tJD <br /> M <br /> j44,� —3 5'p <br /> Al <br /> �G <br /> r16 1I5 <br /> w IVO <br /> SAMPLE DISPOSAL <br /> ❑ NCL Disposal of Non-Contaminated <br /> • �+! ^�U ❑ Return <br /> ❑ Pickup <br /> 117, (o J_zCHAIN OF CUSTODY SEALS Y/N/NA ROOM <br /> SHIPPED VIA: UPS Fed-Ex Hand !J <br /> *MATRIX: DW=Drinking Water; Eff=Effluent; Inf=Influent; SW=Surface Water; GW=Ground Water;WW=Waste Water; S=Soil; O—Other. <br /> ALL CONTAMINATED NON-AQUEOUS SAMPLES WILL BE RETURNED TO CLIENT <br />