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4000 PIKE LANE, SUITE C .:HAIIV-OF-CUSTODY RECORD <br /> GTEL <br /> CONCORD. CA 94520 3 0 8 2 8"j- <br /> (510) 685-7852 AND ANALYSIS REQUEST 4 <br /> »� (000) 423.7143 <br /> ompany Nam : Phone H: (D- _ �j, .L. )UU <br /> .t'ri 1 <br /> FAX 9: ❑ <br /> Company Address: Site L talion: � y m � = Q ❑ <br /> L'rte K IYzaC r� ❑ <br /> Project Manager: Client Project ID: (ff j'w v)d 3](f + + + o t� Ll ( ] <br /> attest Ilnt the pre r field sanrPling Sampler Name (Print 9 ❑ w "' �� � z m = E7 L7 <br /> procedures were used dining Die ��, p ❑ ❑ �`o v rn o a [1 <br /> collection of these samples S 3 o rn ❑_ o N v ? ❑ z {� a <br /> b ❑ n o o <br /> m cy U O O 4. N N FL Q Z' U r, 4 <br /> Matrix M hvd c' - �, m a co m m m ❑ o o v S 5 <br /> Field GTEL w Preserved Sampling w a y ❑ o w M a Qt ❑ ❑ �, ❑ OL N ❑ ti <br /> ? h ❑ x o o d ao v ❑ w W to a a °O m H y ❑ U <br /> Sample lab H a w u N b e N r ❑ ❑ ❑ a 0. ❑ N a <br /> F U rL w 0 ro m <br /> ID (L7b Use v o 0 W Q wo wz W X ¢ <br /> ` 1 o c p n m ,n m m O N c pp <br /> Only U Q p ¢ .=.r 0 EZ U U W as h w w v .q` m 2 m Q Q Q 4 4 4 Q ~ J 4 <br /> • -i �C Vl d O 2 2 7. U 7. O�? ❑ F m m Z O r-- W W W W W W W w w F(L CLU- U.J U -1 0 <br /> 7 -LAS <br /> Mw•_lam - :� - -- - <br /> w • S a ���c <br /> w- <br /> Mw- a :a <br /> TAT Speciai Handling SPECIAL DETECTION LIMITS REMARKS: <br /> Priority(24 hr) fl GTEL Contact <br /> Expedited(48 hr) l-f Ouole/Conlract s <br /> 7 Business Days L1 Confirmation q <br /> Other <br /> Business D,ys [ I P O•R SPECIAL REPOR I-ING REQUIREMENT S Lab Use Only Lot N: Storage Location <br /> QA1QC Level <br /> 011ie 11 CLP r l Other[ I FAx❑ Work Order r!: <br /> Relinquis �ec�by Sa pfe . Date Time Rece' ed b <br /> /7 13 14:00 , <br /> CUSTODY' Relin ulshed ( <br /> RECORDq y Dale Time Received by: ' > <br /> ... IV . <br /> Relinquished by: I" ,Date Time Received by Laboratory: <br /> r ' <br /> Waybill#� <br /> • 1 <br />