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0 -n AO1Sfl3 JO NM-10 Received by Relinquished by: Received by: Relinquished by: Received by: d a (%), Relinquished by: / Signature g I:7 <br />C 4k , IlSampler Printed: Ot\oe LArec-e-D I Sampler Signature: Report Attention: A-LiE±, CA0t7..:—LA12E,L5 Proj# / PO# /Global ID: C....,NpureeiDow.-..- ecieso4- cAPP15.1e AZel - Phone / FAX: e")==1_ 4.-ZR k 'City/State/ZIP: k CA , liAddress: Li CAC) (11,7 • ICustomer: (..• .. <br />S., <br />k <br />cn <br />c <br />r-m <br />tz)..1.. <br />IA DATE V.) <br />G <br />i TIME ] <br />°---r <br />....V <br />0 <br />r <br />....-- Printed Name Pi <br />I <br />Cc. <br />i •., <br />0 <br />(NJ° <br />i <br />0 -- DESCRIPTION/LOCATION SAMPLE TYPE <br />composi e(c) discrete/grab(d) <br />SAMPLE MATRIX <br />soil(s) liquid(I) vapor(v) other (o) <br />BTEX/MTBE/TPH-GAS 8021/8015 REQUESTED ANALYSES <br />V <br />Q) <br />Q•J (i) <br />TPH-DIESEL - 8015 <br />TRPH 418.1M / SM5520C 8 F <br />cr. <br />E....\ <br />••••_.. Company Name Oxy's / EDB / DCA by 8260 <br />8260 - full list <br />\ <br />PCBs - 8082 <br />Electronic Deliverables (EDF) ,Turn Around Time: 24 Hour 48 Hour I I 3 Day I I 5 Day (Normal) I I Special: 1.Y) — .... --• <br /> <br />NUMBER OF CONTAINERS Total number of containers - submitted to the laboratory OBSERVATIONS/REMARKS Notes: Method of Shipment: oeiszeJ). <br />0 09:t7Z '0N ale0wpao