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4U6U VlKt LANt, 5U1 I t U (;HANY-Ut--c;USTODY RECORD <br /> 26892L CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> 3 q ,� <br /> NVIRONMfNIAL 200) <br /> 10 685-7852 <br /> ® "ANOFArORIF9. INC. 423-7143 •.li`, �; ., )'f .; ':, _'•'l ' 1�` �- <br /> Compan Name: Phone H: <br /> L , <br /> FAx a: ❑ o V <br /> Company Address: Site,locatlon � / w� c <br /> ProjectManager:n i s ❑ `. cc <br /> a ❑ $ <br /> J Client Project 1D: (p Zd10370-030.50 ❑ 3 ❑ <br /> En <br /> NAME +1 Li ❑ m x p C)I atlest that the proper field sampling Sampler Name(Print): o ❑ 0 ❑ 1 ❑ ❑ 1 ❑ ❑ <br /> procedures were used during the collection #A Ii g ❑ O § ❑ C r� _ R <br /> of these samples. ❑ 2 o N ❑ .6 C4 0 ❑ c3'03 a ❑ 9 L) <br /> Method _ a a ❑ o ❑ ❑ ►. <br /> Matrix Preserved Sampling .9 ❑ e a a c <br /> Field GTEL q * ° ❑ © � � W3 � o ° <br /> Sample Lab # « N a ❑ ❑ ❑ a ❑ N V <br /> ID (dab use only) 3 a o tr _ d q' u, " ;r o <br /> Q o z z v z u, a <br /> 3 N Q V] d O s x z <br /> i'MGv.r 2, <br /> WJ z <br /> w—z. 1 <br /> 61W-7, <br /> rr1 •— � ' <br /> I 1A <br /> Luw 3 <br /> !►1 w– 1 <br /> w — <br /> TAT Special Handling SPECIAL DETECTION LIMITS FIEMARKS <br /> Prlorlly(24 hr) ❑ GTEL Contact <br /> Expedited(48 hr) ❑ Quote/Contract d <br /> 7 Business Days ❑ Confirmation N <br /> 01her POO SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot R Storage Location: <br /> Business Das ❑ <br /> OA I QC LEVEL. <br /> 13LUE❑ CLP❑ OTHE FAX Work Order N <br /> Sell Is ed by Sampler: tDate Time Received by: <br /> Ml�4si <br /> CUSTODY Relinquished y: Dae Time Received by: <br /> RECORD Relinquished by: Date Time Ra Iv y Laboratory: <br />