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CHAIN-OF-CUSTODY RECORD CUSTODY RECORD , GTE L 20000 Mariner Dr,Suite#300 213-371 1044 AND ANALYSIS REQUEST 76- 8904 E N V I R O N M E N T A L Torrance,CA 90503 800-727-GTEL LABORATORIES INC ANALYSIS REQUEST Pr sect Manager Phone< r51a) 6-71' 2,397 1313_ w ❑ w ❑ ❑ FAX# (5�0) &W-IJI'18 m a co C)F C v ❑ Address, �'� Site location �IMKTOIJj 1A LO ❑ W � LT Ts Gtmc-lP� �/oo�! 5 FLkDp sr ❑ ❑ ❑ ❑ ❑ ❑ a ❑ �, '- U w 0 ❑ CO >+ In In = Q = N Protect Number Protect Name N c� v a m N ❑ o ff Cl o f °C n tc�so2��i /y�ANN$ SRO 31 10 ❑ ❑ a o o 1L Co Z 0 N W ❑ I attest that the proper field sampling Sampler Name{Print) ui �, ° 2 ° ❑ `pQ r Vi L"� f] N ❑ 0 Q O procedures were used during the collection ❑ o m N o m Q M U t of these samples o o a ; ❑ ❑ ❑ ❑ ❑ ❑ a o `2 N J N R \ N NO T) 0 2 7 N IW O Field Source GTEL o Matrix Method Sampling ar y E N o ° ° o a ❑ o Sample of Lab# z Preserved ❑ va i� dco 0 0 CO CO CO 0. 0 ❑ s 3 J O o a ❑ ❑ ❑ ❑ ❑ ❑ �' o ID Sample (Lab use F w a = ❑ — °� g m o N v D: O 0- — y N a0 O N CY "a) Only} w 0 rr m W w o � N U 0 a 0 0 0 (0 a X � . � g N � m O .� O w O D W W x 3 co CO La ip (p Cp 0 a a O o 0 ¢ Q ¢ F U Z cN W Z 2 W w w y �o m ¢ ¢ ¢ ¢ a a . v 0� t�i ¢ o U v # Q W 0 I z U Z ~O F- m m FF-- Il I—° i° W W W w w w LLi F- W J U U N N N Sty-3 A x t'.m. x x it cr It Sr'`i•3 9 I X X 4) 0 o SPI-qA l KX E E E J � c- o sv a -!A I X 1< X X Q_� X X -L A XI Ix Ik�C s?5'3A I x X X SPECIAL HANDLING SPECIAL DETECTION LIMITS(Specify) REMARKS 24 HOURS ❑ eolwd EXPEDITED 48 Hours © f.19 sf Tn SEVEN DAY ❑ a OTHER (#) BUSINESS DAYS a y m QA/QC CLP Level ❑ Blue Level ❑ SPECIAL REPORTING REQUIREMENTS Lab Use Only Storage Location FAX (Specify) c r c �D 61_64 Lot# Work Order 1ID cc Q [ � 3