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4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD <br /> CONCORD, CA 94520 30830" <br /> GTS " (510)685-7852 AND ANALYSIS REQUEST <br /> ".0-101111 <br /> Ixv1,0 xMIxiMC I (800) 423-7143 <br /> Fm <br /> , <br /> ompany Name: Phone #: 11`L.'51 •a lco <br /> 11 r FAX #: ❑ <. <br /> ompany Address: _ 51' L Site Location: m m 0 Cr <br /> M a CJ <br /> cl: <br /> co <br /> rn C9 <br /> Project Manager: Client Project ID; (#) # ❑ "' N q: .a ❑ [7 <br /> NAM S� 1`t?# acs ❑ D 5 N to in = o F <br /> E o U � 0 © z z ❑ a ❑ � w <br /> attest that the probel field sampling Sampler N e(Print U D H a c ❑ ❑ m = ❑ ° ¢ <br /> procedures were used during the y y o v © ° -J -J 7 " m ❑ <br /> collection of these sam les. 3 0 0 ❑ D a v k y a y " o <br /> Nft <br /> Q <br /> M hOd `" U m a U m W U a O °~ H <br /> Matrix ampling ❑ o a a m ❑ ❑ U > cc <br /> Field GTEL w Preserved °° = tn <br /> 0 CL .❑ ❑ w w _J d ° @ °� a ❑ ❑ <br /> Sample Lab a u, ro a o D ❑ ❑ a a- ❑ m b N v <br /> 117 (Lab Use w J p O w �+ w� wF w w X o c ¢ m m w (0 <br /> Labm b N <br /> ` Only / a O ¢ ¢ U OZ. H U iw �N ¢ N i o a a d a n� a a a <br /> I rn a rn a 0 T x x _ Bm 0_ 0 F m m X 2 O H w w w w w UJ W W w F ul <br /> 1 arm ar% <br /> Z Ab <br /> 71 <br /> TATS--- -- Special Handling SPECIAL DETECTION LIMITS REMARKS: e <br /> Priority(24 hr) ❑ GT L Contact <br /> Expediled(48 hr) O Quote/Contract# 1 <br /> 7 Business Days ❑ Confirmation# <br /> 01her <br /> Business Days ❑ P.O. # SPECIAL REPORTING REQUIREMENTS Lab Use Only Lol#: Storage Location <br /> QA/QC Level �- 13 K <br /> Blue❑ Ct_p IJ Other C] FAX[] Work Order#: C 13 <br /> Relinqui i by Sa pl . Date <br /> Q3 Time Received by: <br /> I V13 <br /> CUSTODY Relinquished bale Time Received by: <br /> RECORD I <br /> 1 Relinquished by: Dat Time Received by Laboratory: <br /> i3 43 3 ;S"2� Waybill# �ll� <br /> " r ' <br /> 1 <br />