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4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD <br /> IGTEL 38512 <br /> CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> (510) 685 7852 <br /> (800) 423 7143 <br /> ANAMANESt OTHER ­ <br /> Cornplany Name f Phone <br /> r)iIr r tJe f Li<< } F 700 <br /> Company Address t -i 0 t ) Site Location / � z a ❑ <br /> p` y f �t �>r. l y�/�1 I�r ySS G/117�7 /%�L ❑ ❑ ❑ o <br /> ] U ❑ ❑ N <br /> Project Manager Client Protect ID (#) �o7o�r _ y Y Y ❑ a ❑ <br /> ❑ m m rn = a r v <br /> IJj l AI— I ) i�'!- EVAhS F l I, W LL 6 ❑ p ❑ z z ❑ a p <br /> I -iIlr*sl Ih-it rhe propr,r hold s,mpl nq Sampler Name(Print) ❑ N o ❑ ❑ m E A ❑ o <br /> procedures were used during the "�+ r y om 11 a ? m ras ra- ' J ❑ <br /> collection of Ihese samples ' LfJ/iy $ p cn ❑ $ a o O O ❑ a ❑ a <br /> Method ❑ m u m U o o ❑ ni N ❑ p ❑ r` <br /> Matrix Sampling o 0 o d '� o a d 4 `° o ❑ <br /> rl m ❑ W a a C7 D ❑ a ❑ <br /> Field GTEL w Preserved _ ❑ ❑ W a a m = . © D <br /> Sample Lab a W U o e In ❑ ❑ ❑ a o ❑ <br /> ID rLc�i) Use ~ m 7 oC Q to C7 itl 10 - >• 0 0 0 0 ani m co S <br /> 1 Z W J 0 Ill Q w w W S- W W X 7Z ? 2 C — D Lo fn W W to 0 r0 0 a 2 Q C .p. <br /> only DU a O Q _j ¢ iz- U �Z n W is F 3 Q r h >'10 TJ m a 0 a a R a as a a ri (�j a Q 21 O <br /> e to d to a O M X 2 V zm Ow 0 >* m m x X O F- w w W W W w w w W F W U 0 U <br /> M F 4 <br /> it <br /> 707 <br /> r <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS ,+ <br /> pttotity(21 hr) + GTEL Contact _ <br /> Fxprdii rd{tg hr) Oriole/Contract# <br /> 7 Business ! Confirmation# <br /> Other � <br /> YS <br /> �.J /( <br /> P„atnrss 6A?it- P O ti _ SPECIAL REPORTING REQUIREMENTS Lab Use OnIJ Lot# Storage Location <br /> DAIOC Level <br /> 511w Cftl I oilier FAX(:]_ Work Order# <br /> Relinquished by Sampler 0 L Date Time Received by <br /> CUSTODY Relinquished by V Dae Time Received by <br /> RECORD h , <br /> Relinquished by Date Time Received by Laboratory <br /> lip' <br /> q Waybill# <br /> I <br /> I <br />