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4090 PIKE LANE, SUITE C AIN-OF-CUSTODY RECORD 4 9 5 <br /> MGTEL CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> (510) 685-7852 <br /> (800)423-7143 7M1 <br /> Company Name Phone#(9 6)CoW247 <br /> 7, , <br /> �• C FAX # II Company Address Site Location mr � o <br /> (41 s `�U�-t �oI'zac�0 �k-bn 1 cl NI IN u aCr <br /> s <br /> m <br /> Project Manager Client Project ID (#)010-70ZBl9 �nU�� r) d 2 <br /> m ° oIIIi I , IIz ; > i <br /> I attest that the proper field sampling Sampler Name(Print) ° t I N r G <br /> a o ° I I I I o w g m U <br /> procedures were used duan the S a o '� a o Q! o a a tz a Q in a <br /> g of t� 3 o N < u, I I a N o Q <br /> collection of these samples l Z7 1 7 2 LL m �, U '� o o l i N N 1 1 a O <br /> W Matrix Method Sampling o 0 b o ml o w a a m i 11 1 1 � Iy '1 a ; g LL <br /> W c c m i I 1 1 w w io a s m m a 3 i <br /> Field GT>`L W Preserved Ili <br /> x m �° �° m 00 �i I l I I I I a a I ! 10 M M <br /> Sample Lab # a w C c7 m N �' " r o 0 o a N N x 6 � V ' <br /> F- a[ 7 tx _ u v ¢ N o h <br /> U o a u� �c �a n m o O c <br /> ID Lab Use z w J o a = g o a; zr r w w w v v _� z m Q Q Q Q a Q a Q V a <br /> only 1 Uu a O rt ° r- c� z t" i W r a r a o a a a n. a u. a s t� (L a „ o <br /> y a O x z s U O o F- m m s z O F w w w w w w w w w H w U O U <br /> Q 01 oz x - - <br /> 3 'z <br /> C3 •3 - - <br /> ,,,� tJ ,s _ <br /> VAI) n5 5 - <br /> b? y:l� <br /> }lYlyJ2 03 I�,Zo <br /> WIU L'y — <br /> 1.AA vi lli �i' ii- <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Priority J24 hr) I_-) GTEL Contact Y�ERSE Ftl 1Z F U2 blsso`��b 1�Ap SRM�I�s��(2 F <br /> Expedited(48 hr) Ll quote/Contracts `L <br /> 7 Bus;ness Days Ll Confirmation# <br /> OtherA�t0 "tf,L SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot fl Storage Locatiou <br /> Business Days O PO # <br /> QAIQC Level <br /> Blue 0 CLP❑ Other❑ _ FAX❑ Work Order ri L1(2-7 )-2-s C- <br /> Relinquished ampler die Time Received by n /, <br /> � I <br /> CUSTODY <br /> Relmquishe by D Time Received by <br /> RECORD 7`� YY1 Qcl:30 +� <br /> Relinq hed by _ Date Time Received by Laboratory <br /> Lh � of } 157-` 10' .)0 WabillN �'r r <br />