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4080 PIKE LANE 1O b O `} <br /> L CONCORD, CA 94520 <br /> AND ANALYSIS REQUEST y <br /> "(36 E �15 685-7852 <br /> >• LASCRA°HUE <br /> e Es"INN 00; 423-7143 (OUTSIDE CA) (800) 5443422 (INSIDE CA) <br /> a Company Name Phone# ❑ ❑ <br /> 6 AV441k �r ie�h FAX# ❑ m ❑ <br /> site location m ❑ ❑ ❑ p � e ❑ <br /> Company Address � �S qk O —"10 ' N M v, Cl <br /> S 1 r $ <br /> Q v W �C O L ❑ CD N ❑ ❑ Y <br /> Project Manager Ghent Project ID {#)�Z� 21 Lu -7❑ # en 2 + + t © i5 N m <br /> (NAME) 5� L u- C] N Cl }, p ❑ ❑ <br /> I attest that the proper field sampling Sampler Name(Print) L a ❑ 2 " ❑ g ❑ o © 'R � <br /> w ''� [•s T N Co a a u r` O <br /> procedures were used during the coiiection V-e F\E c7 ❑ n N © ❑ L) t r ❑ a ❑ p- <br /> o#these samvles o <br /> u4i o o a 3 C. m <br /> N o o a 'n m0 nQ. co co o ❑ y o <br /> y Matrix Preserved Sampling a y a �? ❑ w w a. ❑ ❑ LA ❑ ` ❑ ❑ <br /> Field GTEL o ❑ o d � $ ° ❑_ ❑ ❑ aa ❑ � 1N � ° <br /> Sample Lab # �, ~ W CD <br /> N c7 c cv u, a c x Ys m m <br /> C W ¢ E 'o [7 v ? a uQi 8 <br />�- <br /> ID (Lab use only) c� + Qo = o N W� w ,�, r m a a a Q Z a <br /> 0 <br /> sl 3 a ai a o = i i o�o ►= m m = o w w w w w w w uaG uai r v a o v <br /> Z <br /> w <br /> MA4 1A <br /> � MW <br /> M <br /> REMARKS <br /> TAT Special Handling SPECIAL DETECTION IMITS <br /> Priority(24 hr) ❑ GTEL Contact <br /> Expedited(48 hr) ❑ ouotelContract# <br /> 7 Business Days ❑ Confirmation# Storage Location <br /> SPECIAL REPORT IN OUIREMENTS Lab Use Only Lot# 9 <br /> Other PO# <br /> I Business Das ❑ <br /> QA!OC LEVEL • <br /> BLUE❑ CLP❑ OTHER FAX❑ Work Order # <br /> Raiin u he by Sam r to Time Received by <br /> 2,77S --- <br /> M CUSTODY Reli'll by Date I Time Received by <br /> RECORDRelinquished by Date Time Received by Laboratory <br /> .5 <br /> Way til # <br /> N <br /> W ReV 71@1 <br />