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4060 PIKE LANE, SUITE C . CHAIN-QF-CUSTODY RECORD 29588 <br /> • - <br /> GTIC CONCORD,LCA 94520 AND ANALYSIS REQUEST <br /> r 11"R o m u l N Z A i (510) 685-7852 <br /> r11■� lANOMToerrf. IHC- (800) 423-7143 <br /> ;ompany Name: Phone#: <br /> FAX#: ❑ ❑ ❑ <br /> :ompany Address: Site location: Ly e ❑ <br /> ❑ ❑ ❑ ❑ ❑ <br /> 'roject Manager: Client Project ID: (#) VZD '7 ❑ t z- Q � 13W m co V) 4Pv <br /> NAME T�1� Q L w R ❑ p ❑ z z ❑ ❑ r` m <br /> attest that the proper field sampling Sampler Name(Pri t): Y CJ in "iC) 13m 'E 6 (3 J, <br /> 'k 5 ❑ <br /> Drocedures were used during the collectio c © Q ❑ ❑ m a 4 .. <br /> ; these samples. t1 ❑ . N7 LO <br /> Method 2 � ° g 4 a -o 8N q❑ 0 a❑ a-P N;❑ <br /> Matrix Sampling 2 0 ❑ <br /> Preserved ❑ Q ❑ ❑ � <br /> N ❑ aField GTEL m <br /> ❑ra` <br /> `a <br /> ❑ <br /> 0 <br /> Sample Lab # ow Wow � $ � � � oa ❑ 13 <br /> X ° <br /> ID (Lab use only) o w Q ua CM <br /> ua o <br /> -' p o x o o � W. w 9 � m a a a a a a a °.s a 2 <br /> °° a Q � tr f- U z v z y a t- a - a o rL a tL 4 a 4 4 0. <br /> N ¢ y A. O 2 S 7C O�O F m m T x O N w w w w W w w W W r w U -J <br /> - S <br /> mw��t a <br /> a <br /> In LU- a <br /> TAT Speclal Handling PECIAL DETECTION LIMITS REMARKS 17irl 1W —M <br /> Priority(24 ho ❑ GTEL Contact <br /> Expediied(48 hr) ❑ OuolelContract 1 <br /> 7 Business Days ❑ Conflrmalion f tg <br /> Other Po# SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot # Storage Locatlon: <br /> Business DaysI I <br /> T Q 0 i � Y <br /> QA!OC LEVEL .J -I � <br /> BLUE❑ CLF❑ OTHER FAX❑ Work Order# `, <br /> Relinquished by Sampler: Date Time Received by: <br /> CUSTODY Relin hed by: Date Time Re ed by: <br /> RECORD <br /> Re' quished by: Dat Time Received by Lab ratory: <br /> /ro� Wayblll # -- -- <br /> i <br />