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4080 PIKE LANE, SUITE C RAIN-OF-CUSTODY RECORD O 8 O •'� <br /> GTE L CONCORD, CA 94520 <br /> (510) 685-7852 AND ANALYSIS REQUEST <br /> ONMlMIAI <br /> +�l� INS (800)423-7143 <br /> Cam an Name Phone# A 3 -'-76-1 <br /> ` FAX# t 1� (gk- 14qf ❑ ❑ <br /> Company Address Site Location STSG Y►1tZ m p = 0 ❑ <br /> 3tP E eS _ �- 'a��k�0n C �'� m CC <br /> ❑ ❑ o <br /> ❑ o <br /> w rn Elm h ¢ <br /> Protect Manager Client Project ID (#) ❑ L N Q a ❑ ❑ ❑ ' <br /> 7-]`Lo l <br /> �1 ❑ m C ❑ <br /> NAM C, I ❑ m rn rn U-fE10 11 Ll In 1:0 y a r m <br /> i attest that the proper field sampling Sampler Name( rint) ca ; © Q rz p d o El ❑ ❑ ¢ <br /> procedures�ruere used during the t R 1 ❑ m a a N V ❑ 1 4, <br /> collection of the s�samples <br /> �,yL ❑ Q ❑ ❑ o h <br /> N r w a o Q N a ❑ a w ❑ o <br /> Method - m m o o ❑ N N ❑ a o <br /> ¢ Matrix PreSelvecl Sa Iing' o o a © p w ¢ ¢ m w ao c Cl � °c U oo W s <br /> Field GTEL z 0 ❑ ❑ w w m -j ❑ m ❑ a �� ❑ ❑ LL <br /> Sample Lab# a w N w n o m o o - ❑ ❑ ❑ a a ❑ m cv m ❑ <br /> ID (Lab Usel Z Cr u` o w7.6z "O.- <br /> a O �� `° a ¢ T o c o m civ X g m m ra'i 1 t <br /> ` 1 J W lolxhl <br /> w p c a Lo !o co !� co w m O F cn <br /> only U a ¢ D x as \ w w v m a 4 a ¢ 4 a a a a c0 s <br /> EL o a a a a. a a a a m <br /> y a 3 a ai a �o �m o i- ' m m = O F w w w w w w w w w F w o 3 O Ci <br /> ���O wG�i-♦ C+11 'M'' <br /> ii <br /> Y n <br /> i - <br /> ge <br /> J I - <br /> tji. <br /> y 4 M f <br /> E <br /> � F� ,..r5"SR� bass d Pa`s •+' <br /> t, i a ��� �"'' k l'" <br /> * .. � <br /> rti TAT Special Handling SPECIAL DETECTION LIMITS ' REMARk5 4Gn .-r A7- i <br /> Ptionty(24 hr) ❑ GTEL Contact 1 Gt [J C[ <br /> Expedited(48 hr) ❑ Quote/Contract <br /> 7 Busm6ss Days ❑ ,' i <br /> Other 5- Confirmation# ,,! • „ <br /> Business Days P O # SPECIAL REPORTING REQUIREMENTS dab Use Only Lot# Storage Location <br /> QA/QC Leel <br /> Blue❑ CLP❑ Other❑ FAX❑ Work Order# , <br /> Relrnqu ed miller , at Time Received by <br /> CUSTODY <br /> RECORD Relinqurshed by bate Time Received by <br /> Relinquished by Qate Time Received by Laboratory ! <br /> f Wa bil <br />