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7GER <br /> �"'� `ACCO PIR'CFAN��ITE'L� <br /> CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> E N Y 1 R a N M E N T A L (510) 685-7852 <br /> �! usoRAiaRiea INC (800) 423-7143 I�'� r` i'J�! `fit' ''`i; �r t 319 <br /> ompany NamemoI . Phone# <br /> 1 FAX# D �� �23�7 ❑ <br /> CJ <br /> ompany Address Site location Q uj ° z ❑ <br /> 1 <br /> roiect Manager Client Protect fD (#) ���` ^� I ❑ 3 + + w ❑ <br /> civ us H r ❑ a <br /> (n CAP CNI <br /> NAME ❑ ❑ ❑ z z ❑ Q ❑_ 0 <br /> attest that the proper field sam ing Sampler Name{Pr tJ �i o ❑ � ❑ ❑ ; E ❑ o ❑ <br /> rocedures were used during the collection �� # M © C]❑ ¢ ¢ co <br /> o F ? o <br /> f these samples G [3 $ o r!' N o N a o ❑ ra+ `� ❑ <br /> m M U '4' $ ❑ N ❑ a O ' ❑ ^ ' <br /> Field GTEL Matrix Preserved Sampling � a 0 w a a p 0 ❑ q 0 a ❑ <br /> = C C ❑ W W CO J J a7 y ❑ <br /> _ 9 ❑ ❑ ❑ a a ❑ <br /> Sample Lab # ° c; a a <br /> o W Cry 0O w c� C3 m G[ 4S 8 8 8 cNn D U <br /> ID (Lab use on J o o Wy. w N <br /> ¢ O = OR h U i r ry U z N¢T F r > = A a- aa.. aa. a.. n- M a a U a ¢ ai P' <br /> rn a W a. o x z x o.off, m m x x o W W w w w w W W W W v .5 o c� <br /> I ' A <br /> -rs <br /> , f <br /> -3 a <br /> 4 <br /> - 3r <br /> S-10 <br /> C-5�D <br /> TAT Spedial Handling ASCIAL DE ECTiON LIMITS REMARKS <br /> 1J�—�JVr� ewn C-35'ou ft- q? w-- <br /> Priority(24 hr) ❑ QTEL Contact <br /> Expedited(48 hr) ❑ QuotelContract N LG�S <br /> 7 Business Days ❑ Confirmation# <br /> Other pp# SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> Business Das ❑ <br /> AA l QC LEVEL <br /> BLUE❑ CLP❑ OTHER FAX❑ Work Order# <br /> Relinquished by Spier Dale Time Received by <br /> IS-731l0'sz� <br /> CUSTODY Relinquished by Date Time Received by <br /> RECORD Relinqulshed by /ate Time Received by aboratory <br /> Way I # <br />