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4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD 29004 <br /> CONCORD, CA 94520 AND ANALYSIS REQUEST . <br /> l f N V I R 0 N M!N T A l (510) 685-7852 <br /> _ lA{ORATORIE! itic (800) 423-7143 <br /> , A } <br /> Company Name' Phone# fp) 67 ! - ;t N7 <br /> Gms� ak- FAX# 510) 1089 -_V/49 ❑ ° ❑ <br /> Company Ad rags, ttos-7 Port Chic"-5ti /'y Site location Jvc� F ❑ o ° e <br /> CA marikc. CIS- � ❑ ❑ ❑ � ❑ -' <br /> Project Manager Client Project ID (#) <br /> n OSi� ❑ a aaN 'a❑ <br /> 0,Cr034 7q f . � ❑ ro cn ❑►❑ <br /> N � <br /> oe GId a z N <br /> ❑ �' � M ❑ z 13 ° ❑ ❑ <br /> l attest that the proper field sampling Sampler Name(Print) o ❑ a m ❑ ❑ E <br /> procedures were used during the collection 9 © m ¢ <br /> of these sem malk CZA ❑ to ❑ a9o <br /> R o <br /> Method LLmrmptN ❑ c ❑ <br /> Matrix E5 zt ¢ co oo W ❑ > ° 0 o <br /> am ItrS � o v © oc ❑ ❑ oy ¢ <br /> LL w <br /> ❑ ❑ ❑Field GTEL ° W W a❑s <br /> V <br /> Sample Lab # _ w N a ❑ ❑ ❑ n )~ ❑ �a <br /> ¢ N '80 N CO to O Q7 $ <br /> ID (Lab use only) c°v wWC1.11,311 <br /> CC- x a o ti <br /> ,_ o" a w W ua UJ o p x oa a a ¢ a a a a r- g ¢ Tqr <br /> 3 2 2 x P bo O t- in m T 2 d FF- W W W W W W W W Lu FV- W U J d <br /> SYSTEM )wF U I ti 30 I <br /> a STEM I uF 01 1 4.3o <br /> , WEEM LS NvA 07- A 19 <br /> s <br /> eA <br /> 3 <br /> eAT Wv EFF 03 a 1416 <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS ! <br /> Priority(24 hr) ❑ GTEL Contact <br /> Expedited(49 hr) ❑ OuoterContract N_QL 9A 002A <br /> 7 Business Days {{ ElConfirmation k <br /> Other S{0.^11D l pO�_T. SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> Business Days <br /> QA/OC LEVEL <br /> BLUE❑ CLP❑ OTHERC 3 t l�Z d r <br /> FAX ❑ Work Order# <br /> Relinquishedb I hate Time Received by <br /> 1111;-& 1 5r av <br /> CUSTODY <br /> Relinquished by Date Time Received by <br /> RECORD Relinquished by Date Time Received by aboratory <br /> i <br /> R.v 7I9t Waybill # <br />