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�I <br /> 4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECCIRD <br /> CONCORD, CA 94520 5 8 O 7�+' <br /> PGTEL AND ANALYSISREQUEST <br /> � (510) 685-7852 , <br /> eor.,o xi,e.Er,c (800) 423-7143 <br /> Company Name: Phone#: z vc) T-19-2--z-'L i <br /> ❑ <br /> M FAX#: Z c`) 1 -z-ZZ s X1 ❑ D' ❑ <br /> Company Address: 1 Site Location: m ❑ o U 7 <br /> CA ItIZ �.1����c1•.,y `-'/. S �kn1 N ❑ ❑ W W or o <br /> Project Manager. Client Project ID: + p -J <br /> Ci� 3 ❑ of a) N [A °1 Q P Nv ?' <br /> v <br /> L. 4r..-.�.. <br /> (NAME) �:'.1S m oF, c ❑ ❑ ❑ ❑ z z ° ❑ d) <br /> Cl Ir <br /> I attest that the proper field sampling Sampler Name(Print): ,a o ❑ ❑ o ❑ D j ❑ <br /> procedures were used during the N f <br /> th �. N m Q Q <br /> collection of these samples. ,, -iv F ^cam .� o d 'v, ❑ S) a Cq ❑ O n ❑ n- {n o <br /> N� m , ILv d <br /> f Method a m ❑ a s ❑6 m m O O 0 O Q ❑ N� <br /> Matrix Sampling N o o b <br /> O ❑ ❑ M N ❑ N <br /> Flt?Id GTEL w PreSt?I VBd ❑ s c c m - ❑ ❑ w w co m m p ❑ <br /> Sample Lab# a Lu U o E -2 *' ❑ ❑ ❑ a a ❑ J <br /> F WM ('J [L CL r► ,D C'3 rr ]+ e O O O N N - X TL M U <br /> �❑ Lab Use z w p o w n Q �� w w w X c n co No m Na o w O N c o <br /> ` only f a O ¢ � r CJ z C w z W F a ¢ F H a O a- a- d d 0- d a a (j a ¢ o <br /> cn ¢ cn a 0 z z z v �m ON . d H m m 2 2 i7 w w w w w w w w w � w V O U <br /> A �( <br /> ,} e4 C <br /> , <br /> , <br /> _S p K <br /> E <br /> E7-<1e <br /> - 1S•U v <br /> t t d <br /> A. <br /> o m <br /> + _ <br /> , <br /> , <br /> r <br /> 4 5°tA <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS: <br /> Priority(24 hr) ❑ GTEL Contact CA A.A b lLt> A --1 yz� � c : .T i, /9'T�LyI/'-A `13 F iw 6z?U <br /> Expedited(48 hr) ❑ Quote/Contract# c Tip t4 4 �+ t <br /> 7 Business Days V Confirmation - b f- + C <br /> Other sT t'i <br /> Business Days ❑ P.O.# SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot#: Storage Location <br /> QA/QC Level <br /> Btue❑ CLP❑ Other❑ FAX Work Order#: <br /> Relinquished b Sampler: Date Time Received by: <br /> CUSTODY b - <br /> ��__ <br /> RECORD Relin shed by: Date Time Received by. <br /> r 0+' <br /> Relinquished by: natb Time Received by L ora ry:. <br /> Waybill# , <br />