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S t U rt AI'40Pf IItam r■ %1 . , .,Aice+ � ,� x i <br /> CONCORD CA 94520 AND ANALYSIS REQUEST <br /> 510 685-7852 �ttz s <br /> "NVIRONMINTAt � I I �' � <br /> LABORATORIES INC #800 423-7143 ,1 r I ILa <br /> ompany Name Phone# t D—(cn I - <br /> 1 fir 1n4 U FAX# ❑ ❑ <br /> ompannly Address 51te location 711,0 <br /> L ZDti m 0 ❑ <br /> ak-O�Jm 0 ❑ ❑ ❑ <br /> 4tect Manager Client Protect ID (#) ❑ � + + a ❑ ❑ <br /> 6�3CrZ� f ma `�'m n <br /> NAME 20- ❑ 0 ❑ z z ❑ ❑ ❑ <br /> attest that the proper field sa i g Sampler Name(Pant) ' -� L } a o ❑ g ❑ 0 0 El b U <br /> rocedures were used during the ollectlon ❑ ra n n+ ❑ ❑ U ❑ a n ao <br /> t these samples [ - �- a �- v o o a N a ¢ ❑ <br /> Method `° <br /> Matrix Sampling C 0 o a a co p Co °c " N ❑ <br /> Preserved a ❑ w a- a ❑ a <br /> Field GTEL ° y °° �? D o o o J ❑ <br /> Sample lab # a ; �° �_ o N N Q x N <br /> ID (Lab use only) F ❑ ❑ p � �WN b a ro ro O v <br /> a d � CCC F=- U z �„ w z �a¢ 1,- >, a = a a a aa. aa.. aa. aa. aa. a U a ¢ (U rn <br /> W a. o m x z v � oy❑ 1= m m x x o � w w w w w w w w w w la -1 O <br /> ( V <br /> F - -J'U r%:+-- I I I I L I I I I <br /> F - <br /> - „ '�U <br /> - AC <br /> F qo <br /> C - <br /> -SP_ r <br /> TAT Special Handling rl("4t <br /> ECIA TE IONa LIMITS �C�� EMARKS <br /> � !! <br /> Pnonty(24 hr) ❑ GTEL Contac! /J/ta Dom` •� <br /> I <br /> Expedited(48 hr) ❑ QuotelContrael N <br /> 7 Business Days ❑ Confirmation N <br /> SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Locatlon <br /> Other p0 <br /> Business Das ❑ <br /> GIA!OC LEVEL <br /> BLUE❑ CLP❑ OTHER FAX❑ Work Order # <br /> Relin uished b Sam ler Date Time Received by <br /> CUSTODYRelinquished by pate Time Received by <br /> RECORD Relinqulshed by Date Time Recelvedby L ator <br /> P,ayblll # <br /> ---- <br />