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4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD 27927 S <br /> liGift CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> F N V l R O N M E N T A l (510) 585-7852 <br /> IAFORATORIFS INC (800) 423-7143 ' <br /> ompanyN a Phone# F/0 671-2-35 <br /> ❑ ❑ <br /> �!a/ / / p <br /> f 1 J� r' (re- Jd l f FAX# ❑ _ ❑ <br /> om any Address f{�y Site location © ❑ O o a <br /> X1057 Porgy Chi x o I °' <br /> ee C ❑ N E ❑ ❑ y <br /> roje Manage Client Project 1D (#} 0�73j 38 77— /�� ❑ 2 Z ❑ <br /> m M m O O Cr <br /> � 1i5 �ocl� NAME �/c1�,✓ ot" 7 Mo ❑ ❑ ❑ ❑ Z ' ° ❑ ❑ <br /> _ o ❑ ❑ ❑ d E o <br /> attest that the proper field sampling Sam ler Name (Print} o �, Cn <br /> N C <br /> rocedures were used during the collection �},/ /�! G CIL <br /> f these samples / l f (11!�1/Jf'f A ��1 �7� 0 eca w °} C" M c> "' co `�mv a O ❑ n L <br /> Method - "' Co ¢ ❑ ❑ y o ❑ - <br /> y Matrix Sampling m c"a o ❑ o 0- a• Qa c ❑ ❑ ❑ ❑ N w <br /> GTEL Preserved �, n r ❑ w w W � m C] ❑ <br /> Field ❑ z o $ o ❑ ❑ ❑ a a- ❑ w M <br /> Sample Lab # a p� pp N p a o x <br /> ID h' p a D: w LL [O U' U U 9 Q Al �j [6 t�D D cND D TL' N C O <br /> (Lab use only) o w J n g i a ° a wW x ¢ ¢ ¢ ¢ ¢ ¢ r ¢ <br /> a O d � 0 m U Z a ¢ r-. !- } a, a a a n_ d n a a a o- U a_ ¢ m `o <br /> 0 ¢ y a 0 S S S Us oN n r oa m 2 2 O r w w w w w w w w w r- w U S O U <br /> K-7/ <br /> w-Z aro <br /> 1 <br /> w_ 1zd <br /> ` 11 3^ <br /> w — <br /> �r <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Priority(24 hr) ❑ GTEL Contact0�� <br /> Expedited(48 hr) ❑ Quowcontmct# p <br /> 7 Business Days ❑ Confirmation# <br /> SPECIAL REPORTING REQUIREMENTS Lab Ilse Only Lot# Storage Location <br /> Other pp# <br /> Business Das ❑ <br /> QA 1 QC LEVEL <br /> BLUE❑ CLP❑ OTHER FAX❑ Work Order# <br /> I J��y �� - Date Time Received by <br /> / �, <br /> CUSTODYRehnq/wished by Date Time Received by <br /> RECORD Relinquished by Date Time fie/ceived by Laboratory r <br /> Waybill-#� <br /> ev 7191 <br />