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4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD 21 6 0 5 <br /> GTE ` `CONCORD, CA 94520 AND ANALYSIS REQUESTA Q N M E N r A! `5 0) 685-785 <br /> 2 L <br /> tAEottAToRIM INC. (800) 423-7143 <br /> _ <br /> :,ompany Name: Phone#:n �ia� 1rJ z` it '1�y�� <br /> ll FAX#: �,S lit i �� ❑ © 12 <br /> x ❑¢ [7 <br /> Site location: m <br /> m d <br /> ,ompany Address: r- cin Q ❑ Ir o ❑ <br /> pLJ M CS <br /> roject Managers: r� Client Project 10: (#} Soo1A -UI}2-bt5 � N CD 1 ❑ ¢ 't v <br /> NAME o o ❑ ❑ ❑ ❑ LC <br /> Z z p ❑ O <br /> _ <br /> I ;Illpsl Thal the proper field sampling Sampler Name (Print): _ o ❑ v' ' ` L7 ❑ .E ro C] o ❑ <br /> Li ❑ 0 J J W 9 U N c <br /> procedures were used during the collection ����� � 3 ❑ v a �o o ❑ CL r" p <br /> of these samples. �, C6 o o c. <br /> ❑ v ; ❑ a o ❑ <br /> Matrix Method Sampling ❑ a a 8 ❑ ❑ ❑ 0 a N ❑ <br /> Field GTEL Q Preserved a o w W ii a y N <br /> Sample Lab # o ❑ meg � � _ _❑ ❑ ❑ aZ-B � = � � � <br /> C W "� O V' S-. fV cn N N o x °' <br /> !D Lab use on! U ¢ O W `$} O rn < O a '� <br /> ( y) o �� _ 2 m 0 0 0 Q a 4 d J Q <br /> n F- <br /> Q O J 0: u Z 't W a. Q F- T �. a 0 0. d 6. 0. a- a d. 0. U 0. a ami <br /> [A Q W R. 0 2 2 2 V a O�d F Ca m 2 O F- W W W W W W W W W H W U J O U <br /> t <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Priority(24 hr) ❑ GTEL Contact <br /> Expedited(48 hr) ❑ Quote/Contract# <br /> 7 Business Days ❑ Confirmation M <br /> SPECIAL REPORTING REQUIREMENTS lab Use Only Lot# Storage Location: <br /> gree PO# <br /> Bus�ess Ela s ❑ <br /> OA/CC LEVEL <br /> BLUE ❑ CLP❑ OTHER 14 FAX Work Order# <br /> Relinquished by Sampler: Date Time Received by: <br /> +� -67F <br /> C, t STODy Relinquished by: Date Tirtle Received by: <br /> RECORD Relinquished by: Dale Time Received by Labgratory <br /> • Waybill # <br /> ae� 31yi - --- <br />