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(C'r! 2-f3 149 <br />L,ji- ' <br />ffi3pi, = reg �'f� <br />IMMIMMINN�NI��� t <br />ANALYTICAL REQUEST FORM <br />W 16 <br />Date/Times <br />led by <br />1. ❑REGULAR Status <br />by <br />Date/Time �✓ i�6 <br />RUSH Status Requested - ADDITIONAL CHARGE <br />RESULTS REQUIRED BY —7-16-1(o <br />DATE <br />A S <br />CONTACT ALS SALT LAKE PRIOR TO SENDING SAMPLES <br />2. Date Purchase Order No. <br />4. Quote No. <br />3. Company Name—%—t�c7�t�3?�//t SEL <br />A <br />i�LN/!� ALS Project Manager <br />Address �i S/ 5 J2C �o <br />5. Sample Collection <br />K GQ)6%(a <br />; Sampling Site <br />PersontoContact 101K= f I <br />A7- 5::-koG6_5 Industrial Process <br />Telephone (q/,) j�f'Z�2 -711 / 9 <br />,:Z4 - C -??6 - Date of Collection oZ/-z- fell <br />Fax Telephone ( ) <br />Time Collected <br />E-mail Address INA CU M p <br />Date of Shipment <br />Billing Address (if different from above) <br />Chain of Custody No. <br />6. How did you first learn about ALS? <br />7. REQUEST FOR ANALYSES <br />Laboratory Use Only Client Sample Number Matrix* Sample Volume ANALYSES REQUESTED - Use method number If known Units** <br />. �, �'Pa- � I� c.�-PAZ y--- f �it1 �G t� , GG�t,S ; i✓la�d,s - _ <br />* Specify: Solid sorbent tube, e.g. Charcoal; Filter type; Impinger solution; Bulk sample; Blood; Urine; Tissue; Soil; Water; Othk_ [A tt.l <br />** 1. pg/sample 2. mg/m3 3. ppm 4.% 5. pg/m3 6. (other) Please Indicate one or more units in the column eni e Units' <br />Comments <br />Possibl Contamination nd/or Chemical Hazards 1 CL �- [ e t7gltJ 1 f � W Ph e: T <br />7. sham oT <br />ied by <br />Date/Time <br />by d �� <br />Date/Times <br />led by <br />Date/Time <br />by <br />Date/Time �✓ i�6 <br />Still West LeVoy urlve / >all LaKe 1,1ry, U 1 841 L3 0uv-30o-Z1 I3v u4 uv rcvv-f r vv i Ivv- <br />ALS Environmental <br />