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T4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD 28942 <br /> E L CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> Fo <br /> �ENYIRONMENrAI <br /> (510) 685-7852 <br /> LAS ORIEs INC (800) 423-7143 <br /> ompa� n N` / Phone# <br /> —/if�� Irl /!!Y��1��4 � 1'-1 ❑ <br /> t�/Q0 N.t/�#V4 /C FAX# 0 El <br /> ompanddress 0 CC <br /> y Site location ❑ x o <br /> << d ; s <br /> (.A (!` = mo `n n a C1 } <br /> roject Manager Client Protect ID (#} L) Tri 7��/ ❑ , + + ❑ C <br /> �d x ac <br /> t„� S ; . + NAME Lti l"JiU/l �'r tiJ o ❑ ❑ ❑ ❑ ❑ CU <br /> z Z ❑ ❑ o <br /> attest that the roper field sampling Sampler Name(Print) _ ❑ m ❑ ° E ° ° ❑ <br /> p o a ❑ ❑ o 2 c <br /> rocedures were used during the collection <br /> y U01 11 ❑N ° O❑ <br /> ro°° Np <br /> IL <br /> f these samples r co CM <br /> co <br /> ° a El Method °Sampling IS oo aMatrix Preserved w a 9 D a ❑ <br /> Field GTEL N ❑ El adCISample Lab # N <br /> El <br /> �. <br /> ID (Lab use only) v a p x o w a cc <br /> =a r W u w 2 'x m a ¢ $ a ¢ ¢ o ¢ m rn <br /> a o a w m i- U z _ �y¢ t— �, — Q ❑ a a ci o_ a s a a U a ¢ m o <br /> m ¢ rn a 0 z x z _ n o ❑ H m m r x d �- w w W w w w w w w F w U � O U <br /> �u 4 <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS �+ 5 <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# Storage Location <br /> Other PQ# <br /> Business Das ❑ <br /> QA/QC LEVEL <br /> BLUE❑ CLP❑ OTHER FAX❑ Work Order# <br /> Relinquished by Sampler Date Time Received by <br /> lX/" r/-�"�� �T�� c,Cw t <br /> CUSTODYRelinquished by Date Time Received by <br /> RECORDRehnquisned by Date Time Received by Laboratory C� <br /> i <br /> II ' <br /> ev + , <br />