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- 4080 PIKE LANE, SUITE C AIN-OF-CUSTODY RECORD 5 4 5 <br /> 2GTEL CONCORD, CA 94520 AND ANAL YSIS REQUEST <br /> (510) 685-7852 <br /> (800)423-7143 <br /> ,,. ,v•Vo�11N Iwl t , <br /> C pan e i Name Phone# �4::o7 .Z 3� <br /> t`1 <br /> FAX# [ x a� Ll <br /> Company Address Site Location cm7 ' I I r 1 o <br /> m <br /> fl r f I N m <br /> Q I1 <br /> I ( ) p2e-)0 Z$�� I 1 <br /> oleo Manager Client Project ID a <br /> tl ❑ m N m m x 0 ~ R <br /> all (ME) p CTiD 1 m LL o l l t t 1 1 i t z z l z > ' ' <br /> �alte hat eh ope lel sampling lz� Sa pier Name(Print) 2 Er <br /> a ly C m S 0 I I I 1 � s= ' ' o ` <br /> C [J n 11 0 1 Q m _� 0 v <br /> procedures were used during the IpJ c 0 � c N f J t l m a tF4-- � N ° ~ r C <br /> It 1 ❑ 1 N o o n 3 is a rn a° <br /> collection of these samples Ip u. m „ y m �' 1 1 m m 1 1 °� O - v <br /> N <br /> Method Sam Iln N ❑ W a a CJ t I 'to $ <br /> Matrix sampling o 8 c� a �, 31 w a a o M ! a <br /> Field GTEL w Preserved m y "c c m f l Irl w w ao a s W m y -r' <br /> N 1 <br /> z F 11 N a m I I I I I I a n. i1 0 i „ m N y <br /> Sample Lab# a w V o R m t} n N a` u�i o_ x m m C s <br /> r ¢ ❑ m a o a_ ,° C7 0 ¢ �' �i t� m m X0 '2 <br /> a = o <br /> ID m <br /> r! ab L1Se� z w 2 p o w p K:' zr r"' w u"i w a a m a a a a ¢ a a a a <br /> ` only U a O Q F C] z m $,u H Y a F i- a i1 - a to a s it a a a a a U a <br /> a 3 rn a rnO° ❑ m m x 2 Q r w w w w w w to w w r w U a 0 U <br /> "�jp�/tntK <br /> 01 - <br /> taujz 03_ t as �c <br /> 41 <br /> r�I� - <br /> t�w3 07 _ 132° <br /> Jo <br /> vJ-1 ao <br /> SPECIAL DETECTION LIMITS R MARKS ell <br /> TAY Special Handling UEn <br /> �ZOc <br /> f'nnrily(M hr) I i GTEI Contact 1 <br /> F apt tiiumi oft t%o otiotpi`ontract if L <br /> /Ni'lm ti i).rys CuntUrntdtiort II r <br /> oiitrr SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot Storage Location C 3[t <br /> Bustric ,Doy" I PO 11 <br /> ❑AIDC Level Work Order# _� <br /> alit,. refs Oihef4 ' FAX❑ <br /> at Time Received by <br /> Reliliqu st d Sam ler L 6" <br /> CUSTODYTime Received by <br /> Relinqui I by c t�� L` <br /> RECORD <br /> i pate Time Received by Laboratory <br /> Arltngl hed by '� I6 (Jp <br /> Waybill M <br />