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Lab Number t'~y~'~L~ <br />- Analytical I~ab4ratory &. ~o~r~sultam~s, Inc: . <br />_ ,. . _ <br />361 WEST'-~'IF~'~i. AVENUE. . EU~ENE,..dREGON 97401 <br />1~»50~-265973 541-485~$4b4 Fax 34~:-484.-5995 <br />Email anlabinic@rio.com <br />cHA~N of cus~~~r <br />Attention: Ctient: <br />~G Ks - <br />Phore: ~~-~' <br />,~ .t~,'/ .-- "~ <br />_ ~~ ~ 1~~~ <br />Address: ~ <br />i=ax• <br />~~t <br />-~ ~. <br /> Sampler: Print' - ~ Sampler: Signature <br />Field Sample Matriz Coll ection Analysis <br />-identification ~&`'G <br />railC~r~i ._, : .. _~~e--- ,, .Time . ~ottfes ,_ Re uested _ _.. <br /> 11 <br /> lei S <br /> f2 L C3 . O O.p . ~ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Notes: <br />Turn Around Time: Requested: <br />RUSH NORMAL Shipped Via: Refrigerated <br />Reiin wished b <br />~~q y- <br />~~ll - Date Tim_ a <br />---- ----- --- --- <br />c~ /8=0G ~ ~ a o Received b <br />y' _ <br />.. Date-- <br />-Time-- <br />Relinq hed by: Date Time -- Received by Date , Time <br /> <br />Relinquished by: <br />- - -----_ -------- <br />Date Time <br />-- - ---- - Received by Lab <br />oratory: <br />_-~Date_- <br /> <br />- - -- <br />.Time-- <br />COCs General 11-2-45.x1s Note: Standard Terms and Conditions.on Re~rerse Page ~ of ~ <br />