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IJV t�LHl�l111t� �'+ �v.�! nr,�ar wt J d �l V f F y�+ f 7 �• <br /> 31 Er <br /> CONCORD, CA 94520 4r <br /> AND ArNALYSIS REQUEST ` d <br /> (510) 685-7852 - n s a t <br /> ENVIR NMENtAL y ry 1.� <br /> LAPORATOPIF3 INC (800) 423-7143 ,I1�1„I sl ,t- 14i-�.�!'I ii '',f��� 1 �.bi;' t''"9 * „ - <br /> Company Name Phone# Q O V7 + -,43'?7 O <br /> �k1F� I ❑ <br /> 01Z9\1 FAX# ❑ <br /> Company Address Site location It L2 m z Q❑ ❑ <br /> TUB ❑ ❑ ❑ it <br /> Prot ct Manager Client Project ID (#y p�30 17 4 f 0 + + 0 CL ❑ <br /> 1 ❑ m U, m cn s a ►- v �! <br /> NAME ❑ ❑ ❑ ❑ z z ❑ ❑ ~ <br /> t attest that the proper held sampling Sampler ame(Print r ❑ in M 2 ❑ ❑ E ❑ o ❑ `- <br /> procedures were used during the collection # 25 ❑ ❑ ❑ ❑ m ¢ ¢ o a �/� <br /> C ❑ o a N U t~ u) © a a T� <br /> of these samples ❑ a o io a '4 ^ �, a O t <br /> thud c o fn mo < W m © co G 0 p o S <br /> In Matrix Sampling 8 �, Q Q <br /> Field GTEL Preserved G G ° ❑ W Lu ° ° ° a r ❑ <br /> ° ❑ ❑ ❑ a p a N <br /> Sample Lab # cF�<; <br /> O 8 eCco c0 O1D (Lab use only) !1J a2 W 'ty - z M Q Q Q Q Q Q QIJ 0 = z z 9 5 oS o P m m i = 0 � w w w w w Lu EL w w w w L) O C) <br /> C- Z <br /> L^-7 <br /> - j2 <br /> -32 <br /> r- z <br /> _q <br /> TAT pe lal Handling SPECIAL DETECTION LIMITS �y l ' REMARKS <br /> Priority(24 hr) ❑ GTEL Contact <br /> Expedited(48 hr) ❑ QuotelContract N <br /> 7 Business Days ❑ Confirmatlon M <br /> Other PO# SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location- <br /> Buslness Das ❑ <br /> QA I OC LEVEL <br /> BLUE❑ CLP❑ OTHER FAX❑ Work Order# <br /> Relinquished by Sam lar Date Time Received by <br /> l-t"s <br /> CUSTODY Relinquished by Date Time Received by <br /> RECORD Relinquished by ate Time Receiv d Laboratory <br /> r �� . <br /> f 1 <br /> I to V no 1-—-----� _.._._.-- � -- --�--- - � 1 � � Waybill # -- ------ --- <br />