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4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODYRECORD <br /> GTTL CONCORD, CA 94520 d <br /> (510)685 7852 AND ANALYSIS REQUEST 3 HJr-Q <br /> (800)423 7143 <br /> 'ANAC 71 <br /> Company Name ! Phone 9 l)16} 97) `?CO <br /> 11111111111111111F . I :. <br /> A2Cif-I r 1, , FAX # ❑ <br /> Company Address I Site Location � 4 Ll <br /> e CC <br /> {1( �rr rr T rr p r c"n r� ❑ m a fr <br /> Project Manager Client Protect Ip (!!) 3 O � � � V a ❑ � � <br /> 0 070105 Si b V ❑ �- <br /> �1 CI <br /> VJr' 6q,Ir NAM �7 w 13 O m m = O ~ n <br /> a <br /> ,rte'l rr„:11,r nrnper r plrl Sisnplrng Sampler Name(Pant) r-co LL o ; ❑ ❑ p d } ❑ ❑ <br /> 1,roCr S1sirpc,fArr ii5od dirrinq ihc+ a ro Ei ❑ Ln ❑ o _J _� v m g U N ❑ <br /> collection of Ihnse S"lmp}oq ��r� �7r`'� 3 O C7 ❑ O a ❑ ❑ m 4 Q rn o '* <br /> N r EL O O O a. 6 M ❑ fl y ❑ p <br /> Matrix Method O m m m w m ¢ m m ❑ N m ❑ d O � ❑ ^ c <br /> Sampling Q �, o Q ❑ a a a d o ❑ > g J L'+ <br /> Field GTEL Preserved w y a ❑ w ❑ Q <br /> ❑ w w a0a -r ❑ a k ❑ ei <br /> Sample Lail # a -- — y n $` w m o ❑ ❑ ❑ a a 00 <br /> ❑ °1 w ro ❑ <br /> ID f La)) �SC� Z w [w7 0 W a a[_ X (3 0 0 a q r> cv m v v� o_ � � i° m e' Y <br /> 1 a O O O O N N X '2 m C1 <br /> O -� o O �+ w x w w X c n n to ,o <o ,O rc Q N Q <br /> onlyU ¢ x 7 0 2 O w na' _ ~ w w v v i° m 4 Q ¢ 4 ¢ Q Q � ¢ a ro <br /> » � a v, as o z = z �? w O o0 F m m X 2 n. ❑ a n a d n 0. <br /> Q h w w w W w w W lL UJ H fail 0 J O U <br /> _1A1.I __ 1 yb <br /> 'a <br /> � 1 <br /> �_ ►j 1 <br /> -- - ------ --- — — <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS 4 L- <br /> Pnority(24 hr) GTEL Contact r I IN - y 71y 3 '7� r�'S <br /> Frpnditad(48 hr) Ouote/Contracl P <br /> oihrr I Confirmation N <br /> 7. <br /> E3u,,inr ,D;,ys P O tr SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot If Storage Location <br /> OAJQC Level 1,b _ ,) j � <br /> Qiue I CLP ' other L) FAX❑ Work Order 4 l <br /> Relinquished by Sampler Date Time Received by % <br /> CUSTODY I <br /> RECORD Reli`q"'sf,ed by �� _ D to Timp Received by <br /> SE <br /> Relinquished by Date Time Received by Laboratory / <br /> !, A0 0 Wa bill# $ ir7 5 - <br /> i � r <br />