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4080 PIKE LANE, SUITE C S * ' <br /> aGT E L CONCORD, CA 94520 I CHAIN-OF-CUSTODY RECORD <br /> , J (510) 685-7852 AND ANALYSIS REQUEST 3 H Z H` <br /> " •°" '" (800) 423-7143 <br /> � , e•.ron we <br /> ompany Name: Phone#: �� • I OD <br /> Ow <br /> FAX #: p ❑ <br /> :. . - <br /> am an Address: -_i :. : .. r _ z ❑ -: <br /> P Y 1 :: ::,.. Site Location: �.. . �Y�� re _❑_ . <br /> Ix <br /> Project Manager: Client Project ID: (# old �` tp ❑ ❑ 'D p ❑ <br /> Cn <br /> Laico r AM GYd S of Gm o ❑ 13 ❑ ❑ z Co D Q ❑ " w <br /> I attest that the pr r field sampling Sampler Blame(Print � 'o ❑ in �; p ❑ [a <br /> r.. • `a w c E o <br /> procedures were used during the N o U �, ❑ o J J D m v {, () <br /> collection of these samples. 3 o c� ❑ a a U m Q Q Y o n c <br /> S ❑ t? d "' a o N a o o m ❑ a- rn ❑ o <br /> Matrix M fled o +~ m U 'r' o o ❑ n�i N ❑ tl QO ❑ ~ c <br /> Preserved Sampling Q a 2 m ❑ Co a- Q Q 0 © D ❑ <br /> Field GTEL W 0 T N N ❑ a- M o c? w ❑ g ❑ <br /> i W ❑ 2 C C R ❑ W W ap J J ap ey to <br /> i <br /> Sample Lab # n o m w v a a m y n ❑ <br /> P a W v ,v m E o CJ ❑ ❑ a a ❑ m <br /> ID rLab Use) Z w o W n o q m ra v' ri N w o � _) . n <br /> L I C� [L ¢ C7 <br /> O F O d ww W Z W W X O C _ O v7 -,D r0 p .v fO rD O N h <br /> Only U Q O J ¢ H U Z ry W as F 2 W W U .a rd 2 m Q Q Q Q Q Q Q F- d Q -� p <br /> to tL O 2(/ T 2 V v£ O O F Q] fl] X X O F W W W W W W W W W r IIJ U J O U <br /> �AA SCA .-qy <br /> _laml OS- <br /> !y <br /> 09 4 ++ <br /> - <br /> W-�3 0 ;a f <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS: <br /> Priority(24 hr) Cl GTEL Contact <br /> Expediled(48 hr) [l Quote/Contract q - <br /> 7 Business Days [] <br /> Confirmation H <br /> Other <br /> Business Days ❑ P.O. it SPECIAL REPORTING REQUIREMENTS Lab;Use Only Lot N: Storage Location <br /> QA/QC Level <br /> J3'0)( <br /> Blue❑ CLP IA Other Cl FAX[] A Work Order•#: C 31z 2,33 <br /> / s Relinquis by Sa le Date Time Rece-i ed by: <br /> CUSTODY <br /> RECORD Relinquished y:i ' r[l D to Time Received by: <br /> W ��j 3 'i3 11 :crt! [V <br /> Re nquished by: \ t� ,D to Time Received by Laboratory: <br /> (Z {� .33;SO W bill <br />