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4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD 36622 <br /> lGTEL CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> (510) 685-7852,.� (800)423-7143 <br /> Company Name Phone 40 ' (0 1) I f <br /> { AJC FAX# <br /> a a li <br /> Site Location m m ' i 1 1 U o <br /> Compar,�Address a�� ��� �l Ud <br /> Pol A- <br /> ra <br /> Pra ect f�inager Client Project ID (#),q ZGI62 (Q�(13 CI ; NI N �, �, = CL <br /> al <br /> W a p I k f 1 f 1 11 z z I I O� Ir i 1 ! I <br /> ti N I I 1 1 m E m o <br /> I attest that the proper field sampling Sampler Name(Print) a l o " t I I f 5 -J -J a rn 2 <br /> procedures were used during the /�/J'f (��� /� z N t0 ISI cNu I I I I tmi H I I Q N I ! a° <br /> collection of these samples l l LL „ �, U < o o l l N N lot ai o 0 U g <br /> U _ N m Q rA c0 o m aD O � N � <br /> ur Matrix Method Sampling ot ra L l ° w a a o l 1 1 1 �, it u -41 <br /> � Preserved no w w W ll 11 <br /> GTEL " R J <br /> Field w l] a °° - t e I I I { a a f t m Y m n <br /> Z F N ,a rj y N Oi O <br /> Sample Lab# r Q Q a W 0 c it n 8 to o w o J a a t LU <br /> 1D (Lab Use} o ' o f S ° R w w w <br /> ` <br /> only 1 s rn w a� y� �i a a a a a cai Qa a a a U n a d <br /> 0 a N a O � x = �' 5W O� Q � m m 1 x o r w w ui w I w w w w i- w v � � � <br /> e F� oz x x x � <br /> TAT Special Handling <br /> SPECIAL DETECTION l IMITS RFMARKS <br /> Priority(24 hr) I l GTEL Contact <br /> Expedited(48 hr) f I Quote/Contract# <br /> 7 Business Days f I Confirmation# <br /> Other----- - SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot <br /> 5torago Location <br /> Business Days 11 P O N <br /> QAIQC Level Work Order# �, 0 �� <br /> Blue I I CLP 1_1 Other L7 _— _-- FAX <br /> 11 Relinquish b a ler D a r �T� Received by <br /> CUSTODY Rettngwsh d Dale Time Received by <br /> RECORD — -� <br /> Relinquished by Date Timn Received by Laboralory <br /> R� 13 _ Waybill 9 <br />