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4080 POKE LANE, 520 c CHAIN OF-CUSTODY RECORD <br /> (510) 685 7852 AND ANALYSIS REQUEST 37089 <br /> �'"* G CONCORD, CA 94520 <br /> 'v » (1300) 423 7143 <br /> oil RCompany Name Phone it f )3 <br /> `11 7a-'-/ 200 r r <br /> i, ,r• r_ e.r i)IVO FAX 4 ❑ ❑ <br /> � m an ddress 511e Location yS� ❑�no/ <br /> rm- ❑ <br /> l<1c`r t ii; cc <br /> 1, ,T 19 Mrs r� r T//� Y C/f �_ �, ❑ ❑ m <br /> Project Manager Ghent Project ID (1i) 3 ❑ N �' u a ❑ ❑ ❑ <br /> h771�o/ps ❑ d ❑ J a <br /> (NAME) W — 2 ❑ © CO m = O u <br /> I �Ite51 th-it thn ptopor fivid sampling Sampler Name(Print) F p ❑ N z z ❑ > ❑ ❑ m <br /> cc <br /> P10CCrIurPS wnrn uSnr1 dwing thr+ ' a m " v c ❑ ❑ m <br /> } ti O ❑ W ❑ O J J _ <br /> Coltrclion o1lhn,n 5 irn Icy / I c {' L L c Cry N co e Q e ^ <br /> ❑ a o LL CMa a m ❑ a m ❑ a <br /> Methodrn Matrix P eserved Sampling CL <br /> o 8 0 o a �' o a Q 4 , m m p ° a 5^� �1 <br /> Field GTEL m ;, N a m ❑_ El W a a om ❑ ❑ 0 a �' cYr © 1 <br /> Sample Lab z — ❑ = o `o y ao ❑ W W m a m m m ❑ a <br /> P o ° -e n t7 v vii ❑ ❑ ❑ a a ❑ N d ❑ <br /> ID Lab Use t O ¢ W m C7 V� tq7 Q_ m O N N X m m J Z <br /> W w Wi W X ?Z 9 O c W W W w N <br /> G <br /> only U Q O J Q F U zz ry W 4Er yd ~ W W a -0 = m Q Q Q Q Q Q Q 4 U d Q fcc <br /> a <br /> __ - +• }i K Vr d O 2 2 T U �y O°' O H In z 2 O H W W W W W W W W a.W F- W U J O <br /> 1I Y------ '— r Z <br /> 'r <br /> I Z <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Priority j24 hr) GTFL Contact —____ <br /> E,pnrldert{48 hr) Quote/Contraci is <br /> Bu-5 Drys <br /> OihPr�1I i[-�,-r,LY FConfirmmion a <br /> Fl„stness D-Iys PO H — --__ SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot N ` ° Storage Location <br /> OA/QC Level ?— <br /> Bion CLF' 01her I I FAX❑ Work Order# <br /> Relinquished by Sample Date Time Received by <br /> CUSTODY Rehmulshed b I / <br /> RECORD Q y Date Time Received by <br /> Q la 1_ �-- ! :uv <br /> Relinquished by Date Time Received by Laboratory <br /> "-) S/5 S I 9R <br /> 3r Waybill# <br />