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i <br /> ` 4080 PIKE CONCORD, CA 94520 C AND A1VAL YS S REQUESTUITEC. CHAIN-OF-CUSTODY ORD 36579 <br /> §GTEL (510)685-7852 r 1 <br /> "•"°" "r"` (800)423-7143 <br /> Company Name Phone# C3 <br /> { �v r,l 'J FAX# W ❑ i ❑ <br /> -LASite Location M ` ❑ ❑ ¢ o <br /> omp n A r S f m p ❑ ❑ <br /> N a ❑ ❑ ❑ <br /> # ❑ m t -2 ❑ q > <br /> ro]ect Manager Client Pro]ect lD (#)= ,r L t;r'��j ❑ m m s a0 r❑ n <br /> (c2r m ❑ ❑ ❑ ❑ z z ❑ ' c ❑ ❑ Cr <br /> _7 ❑ in �» g o D ❑ ) ai v ❑ <br /> I attest that the proper faeld sampling ampler Name (Print) a o ❑ Ln ❑ <br /> id 04 7] <br /> \ <br /> ` cm o d❑ <br /> ❑❑. �XN° ❑� am <br /> ❑}F-^ $❑NO1 <br /> ❑m0U1 <br /> ato°a (n CJ <br /> # o n.procedures were used during the l! a <br /> collection of these samples v ❑ O <br /> ¢ m > oLMethod Sampling 2 ❑ 0w ❑ ❑ F) <br /> Ma � W w � � mpreserved m <br /> ❑ M Ctrtd GTL w 3z co o <br /> xJ3i$ $ <br /> Sample Lab# >a 0 m 0 0 <br /> Z. Ujx a a <br /> CL � o �o "' az aaw wa <br /> ID ab Use rw > m . LUw o <br /> O w w w <br /> a _O Za m z 77 <br /> Uonly z <br /> _ <br /> t'6� <br /> 777"a <br /> -'0-7 <br /> i, v \Y Z R <br /> REMARKS <br /> TAT Special Handling SPECIAL DETECTION LIMITS <br /> Prionty(24 hr) ❑ GTEL Contact <br /> Expedited(48 hr) ❑ Quote/Contract# I' <br /> 7 Busr ess Days d Confirmation# Lab Use Only Lot# Storage Location <br /> OtheSPECIAL REPORTING REQUIREMENTS <br /> Busmess Days C] P O # rj v G <br /> QAIQC Level work Order# CSOvO S`? <br /> Slue❑ CLP❑ Other❑ FAX 0 _ <br /> EAJ , <br /> r Date Time Receive i <br /> CUSTODY Dat Time Rec ved byRECORD i Wiz/ Q� rpTimeRece ed byWa bi11# i tr k V'1 I i <br /> r <br />