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i <br /> G T 4080 PIKE LANE, SMITE C CHAIN-OF-CUSTODY RECORD 27056 <br /> CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> 510) 685-7852 1.: ;,,f <br /> IF[VIfQN IEN1N' } -:,;�iyry,F7''s�'� � � �i F` <br /> - tAfQfAlOflii, INC. S00 423-743 _ �; _• _„��4.; , <br /> npany Name: Phone#: 6-10 I• - ❑ <br /> CA Lffidwy-YA�Jwl- ; FAX C <br /> c11 <br /> npany Address: Site location: SS rw I)-} i rLa UJz 9 Q <br /> a Pari �Irs ❑ ❑ ❑ <br /> ° ❑ v ❑ <br /> Ject Manager. , Cli nt Project ID: (#) fl -m �± ❑ <br /> o2ozo3� ray• `o = a0 0 g <br /> af-td"r-A- ZQ” NAME ❑ 0 ❑ fT z z ❑ ? ° ❑ <br /> lest that the proper lie am Hng Sampler Name(Print): a 4 A ❑ ❑ o ❑ ❑ 1 © ° <br /> cedures were used during! e collection 11�r r? b ❑o ° 10 <br /> a a ° a ❑ <br /> hese Samples. �T a a ❑ <br /> Method <br /> Matrix Preserved Sampling a a w $ ❑ ❑ 0 ❑ d ❑ <br /> Field GTEL F o ❑ z m ° ❑ w W 4. a 1 0 a ❑ <br /> Sample Lab # o � �' � � � " � � . t � X � � <br /> ID (Lab use only) � low ;�,, i,���,77 � a <br /> xi <br /> O x ¢ iz a i UL w �a Q F F 31 Co a a a a a 4 a a U <br /> 3 in a rn o O x x x V oy o m oa s 4 IL E9i w w w w w u� �.0 ur, <br /> �ri <br /> i <br /> TAT Speclat Handling SPECIAL DEILECTION LIMITS REMARKS v61 CA- <br /> ❑ GTEL Contact - �i'r•�"�- "C <br /> podit 1,8 h ' Quote/Contract! <br /> Business flays Conflrmallon R <br /> finer pp j SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot N Storage Location: <br /> isiness Days ❑ <br /> QA I QC LEVEL <br /> LUE❑ CLP❑ OTHER FAX❑ Work Order# 1C=1 <br /> Relinquished bye995Fffl� Date Time Re ce ed by: <br /> CUSTODY RalEn ie d by' at Time Aecelved by: <br /> RECORD Relinquished by: Date Time Received by Laboratory: <br /> `311414 <br /> N <br />