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4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODYRECORD 29059 <br /> v-r E L CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> ENVIRONMENTAL (510) 685-7852 <br /> 1A60RATORIES INC (800) 423-7143 <br /> Company Name Phone# i v -7 ; j' ,& <br /> 7 <br /> FAX# ❑ ❑ _V <br /> Company Addrelss , /Site location /-7-,- J� i �_ -f ✓ F ❑ ❑ ¢ ❑ �y <br /> At e. rn U o ❑ <br /> ._.,CrYi t r I <br /> r b <br /> ❑ � N U d ❑ ❑ � f <br /> Project Manager Client Project ID (#)C),.t 0 � L�, 6 IV �,'V 1 � � N � + + - ❑ ¢ 0 1 <br /> ❑ N_ U m I... N y <br /> d Q ❑ ❑ m m x © 9 CC 1f <br /> NAME ./I l ♦ d / w ❑ N ❑ T z z ❑ > ❑ <br /> 1 attest that the proper field sampling Sampler Name(Print) � a ❑ o m ❑ � ❑ ❑ ❑ a 0 ❑ ❑ <br /> 3 m U N <br /> procedures were used during the collection / 1 2 v M N ❑ ❑ m a a <br /> ^�.h. e S�ti /�f ✓���v.e/ ❑ $ D r? uoi d c 0 o a o o d © a ❑ ry <br /> of these samples ," N M d ❑ w , ❑ ° ao ❑ o <br /> Method <br /> Matrix Sampling m a y ❑ O w aQ m ❑ ❑ o ❑ , a J N ❑ LL <br /> y Preserved , y y p w W SO J J 2 ❑ r <br /> Field GTEL x = _ � ❑ H ro ❑ � <br /> Sample Lab # w {�(`1�i © a '0 0 ❑ ❑ ❑ � o <br /> O () tt w 4 �D C7 R s. O a N N x M c.� <br /> ID (Lab use Only) U w C1 o w p' w wv w w � 8 `64' ; 8 w 8 o G O a o �l <br /> O � a Q r U z u~ U z �N¢ a za Q a a a a a na a a v a ¢ m rn o l '�rl <br /> 3 y a m a 0 x = x _ = o�D m m x x 0 1-- w w ul W w w w ul w r w U � D U <br /> �r7�nP ' t X11 <br /> 1 <br /> { <br /> rzi <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Priority(24 hr) ❑ GTEL Contact <br /> Expedited(48 hr) ❑ Quote/Contract# <br /> 7 Business Days ❑ Confirmation# " <br /> Other PO# SPECIAL_ REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> Business Das ❑ % �` t�4.i „' /��- <br /> QA 1 QC LEVEL J \ <br /> BLUE❑ CLP❑ OTHER <br /> FAX y Work Order# v' <br /> Relinquished by Sampler Date Time Received by <br /> fi <br /> CUSTODYRelinquished by Date Timb Received by <br /> RECORC <br /> D Relinquished by Date Time v1 R eeivea by Laboratory <br /> i Rev MP Am <br />