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'� 4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD 36572 <br /> CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> (510) 685-7852 <br /> IGTEL <br /> IMO�MORIIi�IMC (800)423-7143 <br /> I Phone# ;,� 7 <br /> Company Name ('�to) b7 ' ❑ <br /> Y 1 , G fio� IU tr �Pod <br /> AX# �1� , ❑ daCompany Address (( J. Site Location y // d ❑ ❑X05L ���'�' I'W`r �h lt-(u � l_� � � ❑ ❑ d a a ❑ � ❑ <br /> G c4' ll1 ❑ V N u ❑ r <br />�> Client Project ID (#) �{ ❑ a N ; <br /> i Pro a Manager tJ �v y U� �l0� ❑ to a ~ <br /> w O O ❑ ❑ ❑ Z co © > ❑ n d <br /> Sampler Name(Print) El C Cc <br /> ❑ ❑ ❑ o rJ © y ❑ <br /> 1 attest that the proper field sampling P N � e m <br /> ,,fy>ocedures were used during the r1� t7 ❑ 8 N ❑ ❑ N ❑ a `� ❑ a <br /> collection of these samples rd r �� ` I/)Kot ; a �' a a o N a Q a a ❑ ^ L <br /> ❑ m M U '� m 0 ❑ m m ❑ O0 c U g m <br /> Method ti 6 a m N❑ o a- na aa. 1 ❑ ❑ m ❑ a J N ❑ U- <br /> Matrix Sampling r K ❑ v <br /> �' Preserved ❑ w w <br /> ' GTIrL a ❑ z r ❑ Q a ❑ <br /> Field $ N $ a �, ❑ ❑ ❑ a o X m 0 U 7 <br /> Sample Lab# a w o o a b o <br /> o urr w LU w uW -5 > - a aa c <br /> ID (Lab Use 0 w o © w 01 <br /> b ¢ 0 C O� v Oz ry w a = r i°,i w w w w w w w w F w U w 0 <br /> Only cn a -J a O x 2 r U �� O� O H m m 2 2 0 H „ <br /> IS 3 077 <br /> 1+ f <br /> s �y <br /> `e ' r Pis <br /> 7{ � 'F ya 4k ry fi 4 S• 4 'i,H�f <br /> pa £6 <br /> REMARKS <br /> TAT <br /> q <br /> s TAT Special Handling SPECIAL DETECTION LIMITS 5 i6F <br /> Priky(24 hr) ❑ GTEL Contact <br /> Bxpedded(48 hr) ❑ Quote/Contract# <br /> 7 Business Days ❑ Confirmation# Storage Location <br /> Other_ SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# i <br /> Business Days ❑ PO # <br /> QA/QC Level Work Order# <br /> Blue❑ CLP❑ other❑��—----- FAX© + <br /> .� Relinquished by Sampler909--Date <br /> g <br /> Date Time Received by <br /> CUSTODY iV Relinquished by Time Received by <br /> RECORD Time Received by Laboratory <br /> Relinquished by Date <br /> ] 4 �� l ' T Waybill# /� <br />