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4080 PIKE LANE,SUITE G • <br /> GTEL �ONCORD, CA 94520 CHAIN-OF-CUSTODY RECORD <br /> r..,.o.�.. �r <br /> 510) 685-7852 AND ANALYSIS REQUEST 34043. <br /> ���•������ t (800) 423-7143 <br /> Company Name Phone# /S'/p) <br /> CS 71 FAX a - ❑ <br /> Cor�tpony Address Site Location w ❑ '• r ' _ ❑ <br /> o �� <br /> Pew--f- C.l, c.� /! �, yrs G f- (. ' ❑ ¢ ❑ <br /> Ccx, i , ❑ ❑ m m <br /> Project Manager <br /> r Client Proles ID (#) ❑ M, + N ° ❑ <br /> 484r- A <br /> I attest that the proper field sampling Sampler Name(Print) ❑ in r, ❑ '` p p _ ❑ ❑ <br /> procedures were used during the c h o ❑ ❑ o _J _ p m ; v Cq ❑_ <br /> collection of these samples /C a.i, a , ` N ❑ o N ❑ ❑ [� ¢ �¢- n ❑ a y A <br /> ❑ a m .r% a o o 0 a m ¢ ❑ a <br /> Method o � � � m a � S ❑ � � ❑ 0 0 � � " <br /> Matrix Sampling g Q a ❑ a ¢ ❑ <br /> Field GTEL W Preserved a ❑ w w w I _J _J b ❑ o <br /> Sample Lab# a ~ <br /> '� m in a ❑_ ❑ ❑ a a% O m b ° m ❑ <br /> ID (Lab Use} o f a '❑ w o W° wF w wLO <br /> $ o a <br /> 1 only / u a o d ¢ v z ry W �, aUJ w R a a a a a a a a a a i� a¢ ¢ m <br /> 3 N a vi a 0 2 x x 0 O n f m m 7C x O i- w w w w w w w w w F w U O Cg <br /> X1 I <br /> t t <br /> i'.7 {'4 'tl f 41 1 ti y <br /> ` Ix• ;y°114 <br /> 1!r i ,i '' +A , '11� ix , I I' Ir <br /> J-M r�1 y/ryy�fy r t <br /> !i t i-fla� vn, _i•Y 'L#ti 'i['F FIfffl } . {. <br /> L <br /> r r r -C4#� '� x y f t r •t '}^Y •eek 4'3''� + ,. 3±•'. r 7 <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Priority(24 hr) U GTEL Contact rl <br /> Expedrled(48 hrl ❑ Quote/Contract# <br /> 7 Business Days CJ Confirmation# <br /> *s SPECIAL REPORTING REQUIREMENTS Lab Use On Lot# Storage Location r n <br />' <br /> Business Days ❑ P O � IY 9 • 1', G <br /> QA/QC Level <br /> Blue U CLP I Other Ll FAX0 Work Order# �S <br /> Relinquished by Sampler Date Time Received P <br /> CUSTODY G- <br /> Relinquisa by y I"ble Time Received by- <br /> RECORD -[-,/ <br /> Relinquished by 1 Hate -Time Received by Laboratory- <br /> ' X95 abi # r <br />