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4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD y3 ''_r f ' 3910 <br /> IGTELCONCORD, 52 94520AND ANALYSIS REQUEST8510 685-7852,.ee..,e.,,, ,.0 840 423-7143 <br /> /+ <br /> Company Name Phone L9 V.0)31 q, 411 <br /> 8rovnd Nakr 0 FAX a 0 372 -F( I_$ t ❑ o �i U <br /> Company Address Site Location Fa t tv fA[u.j m ❑ ❑ o <br /> i � <br /> L ❑ y m ❑ - ❑ <br /> et ID (# U2Pracct Manag r Client Prot " ppIoS 0r <br /> © <br /> la'+j C A� w 0 17 ❑ ° C7 z zZ rJ ❑ o <br /> m <br /> 1 attest that the proper field sampling Sampler Name(Print) CL 0 0 � ❑ n r; 0 ❑ 0 0 ❑ <br /> procedures were used during the /� c c9 2 - 0 ❑ m a B 3 <br /> collection of lhese samples ¢✓.}► 'T pit O o rn n 0. o a 0. ❑ <br /> Matrix Method Sampling N e a N a a m n <br /> Preserved 9 0. a �� W a a ❑ �� C n <br /> Field GTFL w C] _ - "� U ❑ to w ` © ❑ <br /> Sample Lab TLCOW-3) <br /> d �_ �' O " <br /> ID (Lab Use l oTW3C: 0-=t <br /> o w $ Wul <br /> ` a <br /> ` only J a°e �` z N w i n n <br /> .. a t] x x = v O 0 1= at'o m z o w w w w w w w w w r w t� <br /> X ' e T � !• r ' s i A a � '~ fir <br /> - 07-- <br /> jte <br /> lot <br /> 03 <br /> 04 111-T <br /> qX <br /> 06 , ;2 I3 <br /> cly <br /> V s .,•r OJ' J i Y ^� " ' tqF' r� � 7if CI y •-,� F 'PF <br /> i7 i <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Pnonty(24 hr) ❑ GTEL Contact <br /> EKpedided(48 hr) ❑ Ouole/Conlract A <br /> 7 Busir,e s Da Confirmation N <br /> Omer1 SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot R Storage Location <br /> Business Days 1P0 4 <br /> 5 <br /> QA/QC Leel <br /> Blue❑ CLP❑ Other❑ FAX O Work Order p Q Z 0 <br /> Relinquished by SampleDate Time Received by <br /> CUSTODY —= V 4—o2Ci-sYSbc> 10. <br /> I Rehnqui h Date Time Receive by � <br /> , <br /> RECORD -2D-� (� "to <br /> Relinqut hed by Date Time Received by Laboralorr <br /> gl2'Vg i ` 10 Waybill A <br /> i <br />