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1 s� 4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD 26576 <br /> T CONCOIID, CA 94520 AND ANALYSIS REQUEST <br /> t /510\\ 685-7852 ;*^ �rE�ti�►,;���� ., <br /> r14VIBONYIkIAl l 1 �� I �r 7 �tl,rf tl I 1 1 MF +j1�lr� tt.I;.r, L'1ti +� •�iwf <br /> lAloeAT091 iNc (800) 423-7143 ,, _I <br /> npany Name �. 4 T Phone a / Z - <br /> Y Azo 0) 4 ❑ <br /> upon)Address t Site location u' ❑ Q <br /> Vi <br /> �G1rt corpl Q !G� ��.,j��,GC;. ❑ <br /> t ❑ C13nini u a ❑ `�❑ S <br /> sect Manager Client Protect ID {a) p Za�d 3$ y ❑ N + ❑ a <br /> Lu <br /> m N rn 0 a s Q v a <br /> �+ Y F pp In ❑ m Co O r- <br /> Q C. ;� NAME /�.y., 7t`�-c� � �. ❑ N ❑ z z ❑ a ❑ ❑ ❑ <br /> lost that the proper field sampling Sampler Name (Print) 3 a o ❑ � ❑ © ❑ in vC4 9 <br /> codures were used duringthe collection N `° �0 C' 0 w m a a `-' " o <br /> n11S8 yarn les �� U S� ❑ ,�^� m U13 C3 Ia.U in 0 0 N N a ❑a ❑ ❑- _ <br /> Method > <br /> Matrix preserved Sampling m N a p i? w p p ❑ a f� <br /> Field GTEL c © r c ❑ ❑ 13 w m a rn ❑ � ❑ <br /> Sample Lab # c W .. © ❑ ❑ to ° X � s <br /> ID (Lab use only) U o g = o a W � <br /> C; w m a a a Ck <br /> to 0 <br /> v, <br /> °t a D 2 U $ y ¢ Ui tu w w UaJ w w w W IV- w U -j O U <br /> 3rnarna0 = x x _ � O._0 F m rn s x O <br /> ILc4//4Vpyo <br /> 1 Z L 11 <br /> a�a <br /> a � w <br /> a <br /> ya <br /> 7I I M1 sv <br /> TAT -Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> iowy(24 hr) ❑ OTEL Contact <br /> •pedaed(48 ho ❑ QuotelCantract r <br /> F3asln se f)a+ytConlirmallon r <br /> Iver G"" PON— SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot Storage Location <br />� „slness Days ❑ <br /> OA IOC LEVEL <br /> SUE❑ CLP❑ OTHER PAX❑ Work Order Al <br /> Relinqul ed by Sampler ate Time Received by <br /> CUSTODY Relinquished by ate Time Received by <br /> V/x RECORD Relinquished y J DateLaboratory <br /> 1 Time Received by Laborraton. <br />