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4080 ITE LANE SUITE C HAIN-OF-CUSTODY RECORD 508 <br /> V <br /> GTCONCORD CA 94520 AND ANALYSIS REQUEST <br /> (510) 685 7852 <br /> IEL <br /> min <br /> (800) 423 7143 r 7 <br /> Company Name Phone # �` ��� 1 1190 0 glum <br /> l !/t � ,r 11 „� r FAX 4 ❑ ❑ m ❑ <br /> Company Address Site Location m ; ❑ U O <br /> `` v ❑ L7 ❑ m w cc o <br /> r r � rii17 W I Joh �3� � >r r C I ll N v a ❑ I_! <br /> Project Manager Glient Project ID (f!) Z -��. r�179 S . i N N ± ❑ <br /> c 0m <br /> NAME �r I`( 4 c w _ 0 Li N U O z z ❑ ❑ t7 r <br /> I attest shat the proper Imid—implmis g Sampler Name (Print) ❑ v ❑ El "m o <br /> a y p ❑ +n U a -.1 -J m v ( I <br /> procedures were used during the r ' ! 3 n o ❑ Q a C o ❑ w `f' ❑ a <br /> collection of these samples 7' �R N! r, 12 N n a s p h <br /> Method o U °' " U) m a M m m ❑ o o a <br /> Matrix Sampling o n 0 a m [] ❑ w a as ❑ ❑ ❑ a N U ii <br /> Field GTEL <br /> it Preserved r <br /> w _ c ❑ w w *aa a a m y w y D <br /> Sample Lab# a w (.} O 0 2 2 6 `T w 0 N w `v +'n O x T m N M U <br /> Q 7 (� +, U U ff T O O O O N N L N vi <br /> ID (Lab Use l O w p O w o o c n m m o eo m s O a D ro o <br /> 1 Z w O w ww w2 m X ?Z <br /> only u a q ¢ a r c� o w u =a ti a a > ro a Q a a a a a act a. a U as a <br /> O� ❑ H m m x x O r w w w w w w w w w r w u O u <br /> -v IX <br /> -.• I <br /> IH - <br /> r � <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Prnouly(24 hri GTEL Contact <br /> Expedded(48 hr) 1 ' Quole/Contract 4 <br /> 7 Business Days ' 11 Pirmalion# — <br /> Othe�C.F" ImoSPECIAL REPORTING FiEOUIREMENTS Lab Use Only Lot# Storage Location <br /> But nese bays [ 5 H ----- - <br /> QAIQC Level <br /> Mic r CLP 1 Other Cl FAX❑ Work Order# <br /> 6 quis ed by Sampler Date Time Received by <br /> e <br /> CUSTODY f '� y //:00 <br /> RECORD Fte��q;Ykhed �� ate — Time Received by <br /> ,� r <br /> Relinquished by Date Time Received by laboratory K ` <br /> Waybill# n !e ` + n t•r <br /> i ( t <br />