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4080 PIKE LANE, SUITE C `; CHAIN-OF-CUSTODY RECORD r� <br /> L <br /> CONCORD, CA 94520 AND ANALYSIS REQUEST +G <br /> _•'ENVIRONMENTAL {518) 685-78'552 <br /> LADORATORIES, INC, 84 423-7143 <br /> { <br /> ANam <br /> Com e: 1. Phone#: <br /> Gtllr' 1 <br /> ` .0 FAX N: ❑ <br /> Company Address: O <br /> Sit location: 1J, �, p <br /> / @ V <br /> L LL I f } L3 0 ❑ O ❑ <br /> Project Manager, �' r ❑ om <br /> m H Iz ❑ <br /> r / Client Project ID: {#) ❑ - U, '� N o- ❑ <br /> 42 <br /> 11 <br /> ❑ J <br /> Olt-,t (1 ( + NAME ULCl �U 9 /, m m `n " a m <br /> I attest that the proper field sam li Z �� `1 U76� � C o ❑ ❑ ❑ m I � o ~ � Cr <br /> P p P Sample ame(Print: w o 0 in C6, ❑ , z z ❑ ❑ ❑ <br /> procedures were used during the collection � o Q o ❑ o d ❑ p 'E p <br /> ID <br /> of these samples. j'!t.(t j c 0 ❑ v n c4 ❑ ❑ os ¢ a cn pi v <br /> 8 0 �" q o a o ❑ a to .a <br /> M hod N ci v o (L C1 c <br /> Field GTEL Matrix Preserved Sampling a o 0- Q a ° m a ❑ o> J <br /> Sample Lab # o ❑ z c m _: aWWF ❑ ❑ �, ❑ a1= ❑ � <br /> ID w0 W o c� Q - ❑ ❑ ❑ a a ❑ � -�, ° d ❑ <br /> Y) " o N �, o <br /> (Lab use only) v W o o w „ o W � w _' �, T cD s o N N .- X <br /> F JLLJ C7 > <br /> O _J Cr N U ZCO w M Q W W -0 'C° 2 m 4 4 Q Q ¢ ¢ Q a o- 4 CJ <br /> �. R <br /> rn ¢ rn 0. 0 2 x 2 0 p�q p~p m S X O la-• 4QLI W W Lu 4 d 4. 0. 2 U EL Q m rn <br /> w w w w w I- w U o t3 <br /> 3 <br /> /0Q <br /> CC�3 Z <br /> ' P <br /> 2- <br /> TAT <br /> !Lv 1 <br /> O ✓ <br /> E <br /> TAT Special dandling SPECIAL DETECTION LIMITS REMARKS <br /> r I <br /> 'rivriti(24'l! El <br /> ❑ GTEt.Contact � <br /> xpedjfed(48 hr) Guole/Conlract A 5 C <br /> Business Days ❑ Confirmation N <br /> Xher 1 PO N SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# <br /> tusiness Das [� <br /> ❑ y Storage Location: <br /> ., QA I QC LEVEL Bw F Z <br /> LUQ CLP❑ OjHER FAX❑uis �6�ooi-LRelin A - Work Order#q ti y Sampler: Date Time, Received <br /> by: <br /> ftnhed� _ Dat Time Received by:CUSTQDY - <br /> -0 �$4 <br /> � ,� } <br /> RECORD Relinquished by: �+ �` �'v <br /> Date Time Received by Laboratory: <br /> Waybill # <br />