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CHAIN-OF-CUSTODY RECORD <br /> yE L 10500 UNIVERSITY CENTER DRIVE AND ANAL YSIS REQUEST -24389 <br /> TAMPA, FL 33612 <br /> l ENVIRONMENTAL (813) 979-9092 ,� , ' <br /> LABORATORIES INC <br /> ompany Name Phone# <br /> ❑ ❑ <br /> FAX# ❑ ❑ <br /> C <br /> ompany Address Site location °M q _ ¢ ❑ <br /> 1 �Va i— in ❑ ❑ ❑ o ° <br /> L ❑ cl�o r N CL ❑ > <br /> roject Manager Client Project ID"(#) ❑ � ± * ❑ ¢ ❑ ro <br /> C)Z�'� v l S ?�r m o o `� o Q <br /> NAME I� Q N❑ ❑ z z � 0 ❑ ❑ ❑ <br /> attest that the proper Ield sampling Sampler Name(Print) 3 a o r ❑ S ❑ o o El EI d a � G <br /> Q <br /> rocedures were used during the collection r� ❑ m ❑ ❑ ❑ a Q a <br /> r these samples �, o o p N N ❑CD <br /> p z' El I` <br /> Method o Z5 - M m ¢ m ao o � °° o ❑ > `s q o fi <br /> N Matrix Sampling c r 0 a a a � ❑ ❑ �, N ❑ <br /> Field GTEL Preserved to N ° ❑ u' w w J J m ° ❑ <br /> Y u ❑ Y m ao d ❑ ❑ ❑ a a ❑ �n "' W <br /> Sample Lab # N M m <br /> {D (Lab use only) � � � fox a � Eli <br /> � WE W I � � � m a � Q Q < < 23 <br /> Q o [C J CC H U z W xy — a o a a a az a a C, a U a- Q `a� p <br /> 3 rn ¢ uJ a o x x x v oN v r oO m y 2 0 H w w W Lu lit LLI w w w W U 0 C7 <br /> r �s 1' E ��7 <br /> i \ <br /> I 1 <br /> Ck <br /> rI ,1 _ <br /> 3-4 1 J <br /> TAT Special Handling SPECIAL ETECTION LIMITS REMARKS <br /> 'nority(24 hr) ❑ GTEL Contact <br /> xpedited(48 hr) ❑ QuotelContract# <br /> Business Days ❑ Confirmation# <br /> )cher PO# SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location F/� <br /> 3uslness Des rs! <br /> ❑ r ' L <br /> QA I QC LEVEL <br /> v <br /> SLUE❑ CLP ElOTHER �i 4 <br /> FAX❑ + Work Order# <br /> Relinqu ed by'Samp ate Time Received by <br /> Relinq e by date Time Received by <br /> CUSTODY <br /> RECORD ` zZ 11'r <br /> Reim fished by Date Time Received/by Laboratory � <br /> -/ Waybill # - <br /> atW 7191 - ---- --- <br />