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1 CHAIN-OF-CUSTODY RECORD 94390 <br /> n <br /> Asx ���T E L AMP UNIVERSITY CENTER DRIVE AND ANALYSIS REQUEST 7 O t <br /> . v • PAMPA, FL 33612 <br /> �io F o N M I I A L (813) 979-9092 <br /> LABORAIGRIES INC � <br /> o pany Name Phone# <br /> -TITFAX# ❑ ❑ <br /> ompany Address Site locQation <br /> ro)ct ManagerClient Project I {#} 1 ❑ 3 0 S + + a ❑ <br /> ZUJ 0 <br /> 0 cc <br /> `) 5 l t.I NAME _ ED C] ❑ z z L'] ❑ C] <br /> m <br /> attest that the proper field sampling Sampler ae nnt) 6 � ❑ ❑ o 0 E 3 N <br /> ocedures were used during the collection t CD M T N ❑ ❑ rn ¢ ¢ '� m o 1 n o <br /> these samples t r O J� ❑ IL <br /> S o V «Q a o N v a © ❑ fl r <br /> N i° m m ¢ '= ❑ m iU ❑ O U ` <br /> e Matrix Method Sampling 2 o a Q a m ❑ ❑ r s` S ❑ <br /> Preserved '9 o v ❑_ w a a o00 -J ❑ a <br /> Field GTEL c ❑ s c c w ❑ ❑ ❑ a ❑ mo <br /> = © m Q <br /> Sample Lab # N $ <br /> o ¢ to 7 m ¢ C7 m 'c v co ci co <br /> ID (Lab use only) 0 LU o o w o W w w g m a o a - 2 <br /> 'h 4 o m � r=- v z c�i E WN¢ r p } — a o a a na. a s CL a a v a_ a E' <br /> 3 0 o O r m m x z 0 1, w w w Lu w w w w w F- w 3 � O [g <br /> /arc r i, <br /> � <br /> I i1w <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS 3 / <br /> ' <br /> riority(24 hr) ❑ GTEL Contact f C <br /> xpedded{48 hr} ❑ Quote/Contract# � r���( `Ir �3A.I i= � � <br /> Business Days ❑ Confirmation# <br /> 7ther PO# SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot # Storage Location /z <br /> ❑ <br /> 3usrness Das (`{ a QA!QC LEVEL Lx �+ "t r�G 71 (� Y <br /> 3LUE❑ CLP❑ OTHER �j <br /> FAX❑ Work Order# , <br /> Relinquis d y serriple pate Time Received by <br /> k�- - 2 <br /> CUSTODY Relinquis y ' Date Time Received by <br /> � <br /> t <br /> RECORD ` <br /> Relinquished by Date Time Received by Laboratory <br /> w 7;e1 Waybill <br />