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C - <br /> 0 CHAIN-OF-CUSTODY RECORD _ <br /> .+�� AND ANALYSIS REQUEST 29014 <br /> -I-X RA10 R t E S INC <br /> �gt��� tT'.. hr�• ,f!I ; l'.�ri �•,htl r rtt^ t Jr t I � _ <br /> my Name Phone# I(a 3 7 Z ` q 7 d T 9 <br /> FAX n ❑ ❑ <br /> ny Addless Site localion (} lr-? ���rI v m m ❑ ❑ <br /> 05- ac,4-�,r, c l ❑ ❑ ❑ ° ° CC <br /> p ❑ <br /> Manager Client Proiecl II] (#) p p C] c�'v �' a ❑ <br /> X070 7zg� a�:a� w " a ° <br /> J L m ❑ N <br /> NAME Q_ C6 -- J Off,{-cv� ❑ ❑ ❑ ❑ Z Z z o p ti Q <br /> Thal the proper field sampling Sampler Name(Print) a o` ❑ in �"., a ❑ ❑ O E ❑ ° ❑ <br /> Ires were used during the collection n o ❑ Lo ❑ o , 10 con J <br /> samples R 1Q-� � 1 VtV&� ° g ❑ N ❑ ❑ C s r- " s <br /> 11 0 m ❑ a w ❑ a <br /> Method N m t7 V O o N N d Q Z- ❑ ^ r <br /> Field Matrix o g U In a m ❑ co to <br /> o <br /> GTEL Preserved Sampl(ng 4 C3 a ❑ ❑ o ❑ o Cc <br /> Ds rn c f ❑ w w r J ❑ ci ❑ <br /> Sample Lab # r � w PU $ ° ❑ ❑ ❑ M ❑ m ° ° <br /> (Lab use only) �' ' a ca ,� N d m m �, <br /> a o Q c° tz- v z 0, w a a¢ w ' v v m a ¢� `� a a a a a o a <br /> R to Q (n 0. 0 2 I 2 V OT OH m Y S O 4 cUil w W w W IL rill a . W W <br /> i <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS Cly} <br /> 24 hr) ElGTEL Contact �� !. }, ' ` d � �J1J ��l <br /> 1:1d(48 hr) Ouale/Conlracl A -�L1r N <br /> ss pays Cl Coniumallon N <br /> PO ie SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot # Storage Location <br /> pas ❑ <br /> OA/QC LEVEL <br /> CLP❑ OTHER FAX❑ <br /> Work Order# <br /> Reltng fished by Sampler Date Time Re by <br /> 2 1 11'1 _�"- <br /> I s TO D Y ell ��1 Kj � Tlme eceived by <br /> --CORD rnquished by Date Time Received by Laboratory <br /> Waybill # A <br />