Laserfiche WebLink
4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD ` <br /> G ' L CONCORD, CA 94520 • AND ANALYSIS REQUEST 30155 0 <br /> (510) 685-7852 �, .,_r� -.�,. .r - - <br /> FNViRONMENiAI < y�£'�� ti��S t <br /> r' A 4a .k" <br /> - LABORAIORiES INC (800) 423-7143 x� ', �;'} 14' j <br /> Company Name1r1� Phone# <br /> U Wa i&� w FAX# ❑ ) ❑ <br /> Company Address I /� Site location �+ d w = q� ❑ <br /> G�7 <br /> Pe, / �CyhCO <br /> � 1.t1{ r 4�A �7' � CJ' ❑ 13 ❑ ❑ <br /> DCD Ei <br /> s g� <br /> Project Manager Client Project ID (#) Q�p�0 3$7 (,�(j Y ❑ 9 y + + 0 ❑ J <br /> in aw ¢ v °�' <br /> Chr�S �QC16 NAME r� ❑_ d ❑� z CO ❑ a ❑ °C v <br /> I attest that the proper field sampling Sampler Name(Print) t a ❑ w " o E3 ° f �' ❑ <br /> procedures were used during the collection /�_ l "� y ❑ ; Co <br /> a a rn ti o <br /> of these samples '' �G(r1� `�r 2r ❑ o r„ ❑ Q CD a 13 13MetL <br /> 47N N <br /> 12 Matrix <br /> PreSampling a m o o W ❑ ❑ 0 a �"+ g ❑ U <br /> Field GTEL F ❑ s m ao ❑ ❑ ❑ ❑ a a ❑ "' ❑ Q <br /> Sample Lab # w N t, N m <br /> ID Lab use orti U W _ o o W _ w " n °� N N x "' U <br /> y) a J ( o C; u� Ef W� w � a � i m a � �d � Q Q Q Q � � � <br /> p J it U Z 'fv U Z �� Q '5 T T r� O a. a. d [L a d. d. U O` Q y O <br /> cI] Q V) 4. O r _ o p O F m m 2 2 O F w w w w w w w w F— w 0 0 U <br /> NF !6� <br /> 11-jF 163 <br /> 6 <br /> ,AFF <br /> jEFF 16*47 <br /> �F 6• Lfi <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS c. t�-C <br /> Priority(24 hr) ❑ GTEL Contact r� pA ►/p V _/ <br /> Expedited(48 hr) ❑ QuotelContrect# 4C Bion 24 • ik ' �r�K <br /> 7 Business Days ❑ Confirmation# <br /> Other PO# SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# w Storage Location <br /> Business Das ❑ )C;-' W <br /> QA/QC LEVEL 1 <br /> r� 4 I I <br /> BLUE EJCLP 1:1OTHER FAX ElWork O e]�tifw�O <br /> Relinquished by Sampler.* 331 '6-f'00 <br /> Time Re d by i7 <br /> I`� / <br /> CUSTODY Rehn s d by Tim eceived by <br /> �/" �77N "I� <br /> RECORDReli quished by Date Time Received by L oratory <br /> Rev 7/81 Waybill# <br />