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4080 PIKE LANE [.t►aMANALquai E EST ��- <br /> L <br /> CONCORD,CCA 94520 AND ANALYSIS REQUEST <br /> C79E <br /> N ME"T A l 415 685-7852 I E <br /> "� ° 8001 423-7143 OUTSIDE CA 800 544-3422 INSIDE CA <br /> lA/ORArORtES INC. <br /> Company Name Phone# p <br /> FAX# (n m x p ❑ <br /> Company Address Site location i —j-�pr O ❑ ❑ <br /> m ❑ $ ❑ <br /> 0 <br /> Client Project ID V) o ^t� e t Zj ` ❑ m ❑ Q N <br /> Project Manager m M a `f' m M r d ❑ Cr. <br /> J C11V ��( } � NAME � � LL ❑ cm 0❑ ❑ z z ❑ � El <br /> 1 attest that the proper field sampling Sampler Name(Print) 2i 13 9 3 <br /> # d p ❑ n <br /> a p o N ❑ ❑ Co o a � sn " a <br /> procedures were used during the collection Y, M 5 �� ❑ A a O o N 0. a < � p N <br /> of these samples a o �; �i U m � ❑ m ❑ o c <br /> Matrix Method Sampling � 0 a N a a 2 ❑ ❑ ❑ a ❑ <br /> Preserved ,� N ❑ ❑ UJ Lel m a H ❑ ❑ <br /> Field GTEL q ❑ N � 0 � m � � 000MCL � - N � <br /> Sample Lab # `° w � o � ,� � � � � � mNN � x � y <br /> (7 Q w ca C7 v v in Q 4 p <br /> Q ❑ <br /> �w(Lab use Orly) wlD J HOo <br /> 4b <br /> U Z W a Fa Q M F-- a• }. 0. Q d <br /> fA a O S S x V ON© F m m Z Y F- Lel W W W w W Lll W W W U O U <br /> I � r <br /> r <br /> i <br /> M <br /> VS � <br /> p <br /> r I <br /> TAT Special Handling SPECIAL DETECTION LI ITS REMARKS <br /> Priority(24 hr) ❑ GTEL Contact <br /> Expedited(48 hr) ❑ Quote/Contract N J <br /> 7 Business Days ❑ Confirmation# SPECIAL REPORTI EQUIREMENTS Lab Use Only Lot# Storage Location <br /> Other PO A <br /> Business Das ❑ <br /> QA 1 QC LEVEL <br /> BLUE❑ CLP❑ OTHER FAX❑ Work Order # <br /> Relhn i ed y Sam le D to Time Received by <br /> Rel1nqdmKeYby Date Time Received by <br /> j CUSTODY <br /> Date Time Received by Laboratory <br /> RECORD Relinquished by <br /> a <br /> Waybill <br /> '� Rev 7191 <br />