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SEQ OIA ANALYTICAL SAMPLE PLE PXCEIrT LOC <br /> Cl 1W-1r NAM-, �&���-- �^ DATEReceived at r.,ab: f�� Drinldn vs:ct f <br /> REC'BY (FpxgT) �. TZM Received at Lab: regulatory purposes. 3CL51 Y <br /> WC7R ORDT.R: L LOG j'Z—j Wastewater for <br /> reguIatwry pwoses: YES <br /> CIRCLE Tom:AP1'P.0 UA'= PONSY, LAB SAMPLE I1�tT9 <br /> CONTAIN <br /> CLIEN 'ID DESCRIPTION MATRIX SAII�P.L CONI)£�01 TC. <br /> I. Qntody Seals) <br /> 2. Chain-of-Custadv t J A cut"' 03 <br /> "a.Traffic Reports of U <br /> x <br /> Pa2jfM Lim; Present � t �" <br /> 4. Airbiff., Airbill J Sri ker Qd� <br /> I <br /> Present! t � <br /> 5. Air'aill#: <br /> 5. Sam ie Y abets- t!fL enc Q <br /> 7. sample IUs: U4diNa Listed ( , <br /> a Chain o-CW%todv , <br /> S. S=Plo Comution, tl l3ro nom! <br /> t <br /> 9. Does kxbr nation on <br /> custody-reports,t-dfac <br /> reports and sample <br /> ° -labels a ree? Y . f? o'" <br /> 14. Sample received within <br /> hod time: ' Ye INo* j <br /> 11, Pxaperprmervatives <br /> rued ye !Nom <br /> 12. Temp Rco at L;b: <br /> (AcocptMep=Se for samples d <br /> .cqui:: thclznal pres,:4•i!2°C) f Na** <br /> Sian ifan <br /> I'Circe Con tact <br /> ' ec1: na er and _ <br /> ., _ attach record of resolutiou. <br /> o Aecotpt Log <br /> 2.2(M1102) <br /> islon 2.1(1,9110J00) Page <br /> � r 15102 <br />