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--4480 Q!f[ �'N>' SMITE C /yt��!!c C�e CHAIN-OF-CUSTODY r�ECORD <br /> �_ � '- C019Cp ppjF�p,_LG.}�y 64520 /►1 AND ANAL YU - <br /> ENVf'RDMMFNTA! MO) VV5!7 E5 ��.� SREQUEST 26587 ' <br /> LARORAlDRIES INC {C!!N <br /> (809-42�}]43=- TSO b( - <br /> ompany Name Tc�tc�, Ej1v.'6ltv1E�E� Phone# W� QEkrrF I . <br /> SVf-V tS lit or �Ib <br /> impany ddrg,s 4�eo Sw( C.ry-, CA FAX# ❑ <br /> r`at., ��t-1er7E.C�r.0(tibL, / Site location w ❑ <br /> otect Mana4er �� C13 ❑ 0 ❑ <br /> Client Protect ID (#) (�Z('+ j .l ❑ n CV u a ❑ <br /> NAME , t r J o o ❑ ❑ m m <br /> (lest That the proper tfetd samphn9 Sampler Name(Print) N ❑ Cl z z p O ❑ ^ <br /> icedures were used during the collecllon � o u> C-, <br /> these sam les �/`LLLC b o q ❑ to ❑ d q a U <br /> ❑ np O ❑ d a N ❑ ❑ (] V O i-- O <br /> Method N b °" C Q d — p q V5 C1 Q Cn a <br /> P.- <br /> Field <br /> Matrix v m N d m m ❑ N N ❑ a ¢ � ❑ ❑ C <br /> co <br /> Sample GTFL -- Preserved Sampling W a 0 d o m a- CLo ❑ o o U <br /> �� Lab # 00 fl w m 0 '^ 0 a °' © W m ❑ a 8 ❑ +i <br /> o lx Wv ❑ ❑ 0. a m " " ❑ ❑ <br /> (Lab use only) V W �, c ti 0 C7 d ❑ g N <br /> ca N <br /> a O H U N Ul a sw N W c i + ''D eQn w eNn 'Nn X w $ <br /> a s a ¢ ¢ a a a a s v ria o <br /> m Z x O w W u4i w w U 0. ¢ ,�, rn a <br /> W W W W i- W U _j O U <br /> /2-zS, <br /> � , -/3-1/0 ' – — <br /> TAT <br /> T� � n ��Ty Special Handling SPt=C;AL DETf=CTiON LINtITs <br /> 'rc'c pl REMARKS <br /> o{+ly(24 hr) ❑ GTEL Contact <br /> ped+led(48 hr) ❑ 0u0Ie/Can1rac!Af <br /> 3usrness Days ❑ Confirrmalton N (f <br /> h@r PO N SPECIAL REPORTING REOUIREMENTS <br /> SUMS Das ❑ Lab Use Only Lot # Storage Locatlan <br /> QA!OC LEVEL <br /> UE❑ CLP❑ OTHER <br /> FA Work Order# <br /> Relr wished by Sampler <br /> Date Time Received by <br /> J <br /> ;USTODY +nquishedby <br /> Vewt <br /> -3 <br /> Isys <br /> Time Received by <br /> R E C O('[[]]1 D Rehnqurshed by <br /> Date Time Received by Laboratory <br /> l� D�8�.,�3UU��- <br /> ngl 9'7 Q3 3%30 M waybill # Mo(31LV,C9C/q <br />