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I LE CH4 M LA6 <br /> AND ANALYSIS S EQUESTORD 72- 8713 CUSTODY RECORD <br /> CA) <br /> r^ or +FCA) ANALYSIS REQUEST <br /> Project Manager Phone it ❑ ❑ ❑ l <br /> _ < �'Vi �•i,r 5 �``J FAX 8 ` l� 3 7�?-�S 73y m Cl) o ❑ a ❑ r <br /> Address /Y p/ / ,/y s!� ��7 S� Site locatron ❑ Q "' _, <br /> Zt w ,2 ❑ ❑ ❑ ❑ n ❑ N U rt <br /> C{� S c c� tC�r�j�j J m G71 T ,li l!3 Q1 _ N - <br /> C1 r-t-7 �'� `dr -^moi �i Gr tiyJ F O 7 N Gp c N 2 < y A <br /> Project Number Project Name 2 CO w cl o ,° + + >O ❑ T <br /> y N -4,' ❑ d yr Q m N cn U o <br /> r ❑ <br /> -- - 3 ro ❑ N ❑ Dp o a z z � ro w <br /> I attest that the proper field Sampling Sampler Name(Print) N v♦ vJ vnv o X Q EM <br /> ❑ QJ <br /> �0o q <br /> I <br /> Aw Jmo <br /> procedures were aped daring the collection a U <br /> a <br /> of these samples ❑ ❑ ❑ ❑ ❑ ❑ <br /> � 4 LL o <br /> Field SourceGTEL fur) Matrix Method Sampling cco ❑ " oNmaaoO <br /> m E c 0 ❑ v a ❑ <br /> N Q Ocli <br /> WMco <br /> Y ❑Sample of Lab Preserved Ll ° q y ❑ <br /> ID Sample (Lab N � 06 o ❑ ❑ ❑ ❑ ❑ o m <br /> ° 0 0 It to ° <br /> only) w (9 e <br /> w w !Lp a 0 N N <br /> O O UJ x w O IL o > s a <br /> " Z " _ _ aD z w wx z 0 ¢ a a v v v <br /> ¢ � i z � <br /> T- z 0 <br /> ...,� <br /> �^ I a H m m r a r- r w w w w w w w r w -J Ulu] m m m _ <br /> t1 Cc a <br /> `4 - - - --— – -- E E E <br /> -- m m <br /> /s1<e- <br /> t y <br /> SPECIAL HANDLING SPECIAL DETECTION LIMITS(Specify) REMARKS <br /> 24 HOURS t] � � f 1 1tE' <br /> EXPEDITED 48 Hours ❑ <br /> SEVEN DAY ❑ Co,�7`7�Arrc�OTHER (#) BUSINESS DAYS r <br /> QA/QC CLP Level CI Blue Level ❑ SPECIAL REPORTING REQUIREMENTS Lab Use Only Storage Location <br /> FAx EI (Specify) c <br /> Lot# Work Order# y <br /> Cc Q <br />