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4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODYRECORD 28357 <br /> TEL CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> ",-L;K V I*O N MEN T At <br /> (5 Q} 685-7852 <br /> LA80RAT09IES INC (800) 423-7143 <br /> ;ornpany Name Phone# ';/ 167/ 7 <br /> t l <br /> �mFAX#Site location d7 c r ❑ <br /> ❑ <br /> Qess <br /> s "se13Q <br /> C1 <br /> c,,—,,A C cr) pp <br /> ❑ <br /> 'rotect Manager Client Protect ID LO + + 0 ❑ ❑ o <br /> CD m co (n _ ¢ <br /> rc NAME 1vhn ti �•) n ❑ ❑ ❑ ❑ ❑ CO z❑ O ❑ m <br /> attest that the proper Geld sampling Sampler Name(Print) = ❑ ❑ v, rN, p ❑ f © ❑ ❑ <br /> irocedures were used during the collection , # 2 O 0 ❑ ❑ m a ¢ n o -J � o <br /> )f these samples �n° t3b. cls KY,,— o❑ .8 ❑ a o Q 4 o c a ❑ d O ❑ a <br /> N f7 U O O ❑ N ❑ L 0 '1 <br /> Matrix Method Sam Irn C � C) o a W o a a ¢ o °° � o ❑ � U. <br /> �, Preserved P 9 c7 a ❑ w a c- <br /> >' ❑ ❑ c, N ❑ q` `�" ❑ `�.� <br /> Field GTEL ❑ ❑ w w m a. w w } y ❑ a -� <br /> Sample Lab # w U �� ��c} Q A a c�L7 ❑ © ❑ a a ❑ Y J - <br /> 0 0C C7 rL y ru cv y a o o e`r�e N Q X v' °� M s J <br /> ID (Lab use only} w ❑ ❑ w �-�, ID W � to o CIA C y <br /> a a ' O x C w a w�I- w w a o s m a a a ¢ a a a i- a rn P r <br /> -J CCr v z v z y a a ❑ a a n. a 0- a o_ a 5 a ¢ �, `o <br /> ui ¢ US 0 2 5 2 _ 5 0 0 H m m S Z O F w w w w w w w w w F- w U -J O U <br /> I <br /> rT <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> R_r-cEtvFc Gc(' <br /> 'rionty(24 hr) ❑ GTEL Contact `► <br /> Expedited(48 hr) ❑ QuotelContract# '`ll <br /> 7 Business Days ❑ Confirmation# <br /> )ther "�T''t [ _ PO# SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location r <br /> 5 114 <br /> 3usiness Das ❑ <br /> QA/OC LEVEL {1 N- ?;0 Y <br /> SLUE <br /> El CLP❑ OTHER Work Order# C-3 f ` , 0 � -r C l yl"(10 Iii <br /> i A, <br /> Relinquished by Sampler Date T[me Received by <br /> CUSTODYRelinquished by Date r � Time Receded bye--' <br /> RECORD 'Relinquished by _ fDate Time Received by Laboratory <br /> v7 W <br />