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4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD 36598 <br /> ' <br /> IGTEL CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> (510) 685-7852 + <br /> ' "..` (800)423-7143 <br /> Company Name II Phone# Ib) C7 i— '139.7 ❑ <br /> 7Ad, �Pt �! CY FAX# S` © ❑ °' ❑= a f7m r_7 aCom nress 40$� P6r �ht{��� ate Loc ion rrt ciaC A r r 7 1 a H cc 8 <br /> h Ca S 26 ` N Zn N N n d ❑ ❑ ❑ <br /> ❑ ± ± ❑ Q N ; <br /> Project Manager Client Pro)ect ID (#)�'�p 011177 6M ❑ a N o h <br /> C is Wit,cla C�a��� Gr Imo+ h o � ❑ ° rJ �� fin ° E b ❑ Cl <br /> I all that the proper field sampling Sampler Name(Print) = L g 1N ❑ ❑ m a a § —' <br /> procedures were used during the o v' a <br /> MU r CZi C] , N U u ❑ a ❑ <br /> collection of these sam les r <br /> 0 p <br /> ❑ � LL m ai m ¢ apo � ❑ � m ❑ � O o � ~ z <br /> Method H o a o a ¢ a p � <br /> U) Matrix Sampling 0 n cs a ❑ ❑ w w uai m a v, ❑ Q p <br /> Preserved N <br /> Field GT Cl: W $ ❑ N X d N 2 H <br /> z <br /> Sample Lab# a m Ww ws w w $ , ro m a a a ¢ a a a d a b 2 <br /> ,r,7 <br /> ID Lab Use z w a O Q w O MT x r w v a _ <br /> U ¢ p d � ¢ [3 z ry w i w M a }- ~ ' ° w CL, w w ul w w w w w v o $ <br /> only ¢ rn d o x x z D+a 0- ❑ >- m m x x o <br /> CA cig WFS <br /> T <br /> "l x <br /> 1 , <br /> t <br /> TAT Special Handling <br /> SPECIAL DETECTION LIMITS REMARKS <br /> Priority(24 hr) ❑ GTEL Contact <br /> Expedited(48 hr) ❑ quote/Contract# <br /> 7 Busi ss Days ❑ <br /> _I Confirmation# + Lab Use Only Lot# Storage Location <br /> 011ier rii SPECIAL REPORTING REQUIREMENTS • y <br /> Business flays ❑ PO # -S 47C <br /> QA/QC Leel Work Order <br /> Blue❑ CLP❑ Other❑ FAX❑ <br /> 7� <br /> Relinquished by Sampler D e Time Received by� <br /> CUSTO' {e v <br /> D i Relinquished by Date Time Received by <br /> RECORD <br /> Relinquished by 0 t, E�Time Received by Laboratory <br /> B 'S Waybill <br /> 0 <br />