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i ` <br /> 4080 PIKE LANE, SUITE C CHAIN--OF-CUSTODY RECORD 36542 <br /> ' <br /> GT E L CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> (510) 685-7852 <br /> IMYFOMWFN;N1 (800) 423-7143 ANALYSIS REQUEST1 <br /> iFOaIOFit] [ <br /> Company Name Phone# <br /> ❑ <br /> FAX# ❑ z ❑ <br /> Company A res Site Location ❑ ❑ m o <br /> 0 El <br /> r In N <br /> r joct M nagc�r Client Project 1D (#)� �� # ❑ J <br /> .* ❑ a N >- <br /> 1 �r� 11010 ?- ❑ r a o <br /> U ,,,, m ° ❑ ❑ Z Z ❑ ° o <br /> (N ET N C ❑ <br /> 1 attest that the proper field sampling 11 Sampler Name(Pant) a ❑ g ❑ c -J -J a d a ❑ <br /> procedures were used during the ! �,,r� C `� IT M T N ❑ ❑ m a a rn L <br /> f r i Y rid L( 3 o O co o a N Uo �o ❑ a m ❑ a <br /> collection of these samples ❑ <br /> p i c m <br /> U. w " m m ¢ m amo ❑ m m ❑ p 0 o O a <br /> �, Matrix Method Sampling o , o a y ❑ ❑ w a a o ❑ ❑ ; y f 1 a F N ❑ W <br /> Field GTEL W Preserved o = 0 o d ❑ ❑ w w m i J co N� h ❑ <br /> Z F o ❑ ❑ ❑ d ❑ :° m N J <br /> Sample Lab# a iIJ U (} W O O O O N N N u1 <br /> y p z w o w w� w� w w x � a ¢ a L m 10 m m o O a o <br /> IQ (Lab Use o i- Q o x o ° _ x r w w v v m = m a a a a a a a a <br /> l only J/ a ❑ N w �� r a r r a T a ❑ a a a a a a a a U a a o <br /> 3 u�i a -J a O z = s v �� o� o F- m m s x o F- w w w w u� w w w w r w U O }U <br /> B ,�1 <br /> "A LIP. <br /> § PW <br /> ���,�{wN'+gY {�{'',,' S <br /> f`Dl2'3Vii:rte. 1� 1 <br /> i <br /> M 1 m M <br /> Y � <br /> r +Jtft <br /> SPECIAL DETECTION LIMITS REMARKS <br /> TAT Special Handling <br /> Pnonty(24 hr) ❑ GTEL Contact <br /> Expedited(48 hr) ❑ Quote/Contract <br /> 7 Business Days ❑ Confirmation# <br /> Othe�_ SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> Business Days 11 P 0 # <br /> QA/QC Level C 0 Z S 13 <br /> Blue C] CLP❑ Other{� FAX Work Order# <br /> Relin$uI hod Sampler_ pate Time deceived by /� <br /> CUSTODY <br /> `- <br /> Relinq , ha y , ate Time Received y <br /> , `ay z� o <br /> RECORD <br /> Relinquish Dat Time Receive y Laboratory <br /> D , . ��/�� }, 1 I ' — / z r Waybill# <br />