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i 4080 PIKE l ANF , -3JI If C -- - . CHAIN-OF-CUSTODY RECORD <br /> GTL CONCORD, GA 94520 AND ANAL PSIS REQUEST" <br /> ENVIRONMENTAL (510) 685-7852 <br /> LA90RA10RIEs INC (800) 423-7143 <br /> Company N-ime Phone# LSI0) 6-jI —.73 S,J <br /> I ❑ ❑ <br /> I rJ �CvKy <br /> 4W "lT �2C V.L FAX# ❑ m ❑ <br /> Company Address Site location qooq p, C m LD <br /> ❑ <br /> Cn <br /> W Cr C3 <br /> 31 a w �T �' �./ w ❑ p r CN 2 ❑ ❑ > •�i <br /> Protect Manager Client Protect ID (#) 'U,Z�]C+��� ( m 4� ° '0 ❑ < a e <br /> I�L SScc h2 NAME t LL ❑ try ❑ Q z z p = n <br /> attest that the proper fiel sampling Sampler Name(Print) yEl <br /> "' °3 ❑ ❑ ° E]a o O J J m U N <br /> procedures were used during the collection fit}(, L y`yl°- ❑ D acli o o n ❑ C `~" 0 a <br /> of these samples I o m �, U 'C o o N N o ❑ n <br /> Method _ U) m a ❑ ❑ ❑ o o `� <br /> N Matrix Sampling m a �* a ¢ a a y a` N ❑ <br /> Field Preserved ° ❑ "' w m J J 03 Yr <br /> GTIwL a 2 0 4 ❑ W ❑ co ❑ ,� <br /> Sample Lab # o ❑ u ❑ a ❑ '� N J <br /> r_ h' W N ,U a N N m V u7 4 d m U .� <br /> V w f�0 <br /> � � � T O O O 4 N N X � .Lr � N C N <br /> ID {Lab use only 0 W ; o r o C �, a =J ui W a �, o A - <br /> Q Q Q Q Q Q Q J Q Of `O <br /> a 0 ¢ r U z Z �a a H > , — a o n o a a n m aZ a v a a m o <br /> cn ¢ N 0. O 2 x i U oN❑ Co m T z 0 I— w w w w w w w w w F w U J o U --- <br /> _ 31 1'$7 'f <br /> I <br /> I <br /> TAT Special Handling SPECIAL DETECTION LIMITS R—ElARKS0. �5 i vkS t >'�'+�t� <br /> 5 W <br /> 1� �ti 1 0 <br /> Priority(24 hr) ❑ GTEL Contact <br /> Expedited(48 hr) ❑ Quote/Contract# <br /> 7 Business Days ❑ Confirmation# <br /> SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot fl Storage Location <br /> Other PO# <br /> Business Das ❑ A m� <br /> QA 1 QC LEVEL <br /> BLUE❑ CLP❑ OTHER FAX❑ Work Order# <br /> Relinquished by Sampler D'�attee Time Received by <br /> 73 Id 116(-� kox, <br /> TReceived b <br /> C�STS�Y Relinquished by Date Time y <br /> It r> <br /> � Reinqutshed by Date Time Received by Laboratory <br /> RECORD <br /> Rev 7191 <br />