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4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD31437 <br /> MIGTEL CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> (510) 665-7852 <br /> !�..l�F.. =` (800)423-7143 <br /> 1!!° I C I 1 ! t <br /> Company Name Phone# (SLa) o 1—'�30 <br /> CnrouLU& Tec�tb FAX# 510) 685'- y r y I I7 W 1 <br /> I I M <br /> Company Address to Location 1'j��j ma r u m ; I IT1 d o <br /> y 4057 or} ��trc " ►- t <br /> f �' g m I l I I 1 1 ^ 4 <br /> CO 0r Sao q��'L(I L� r � a 7 <br /> � <br /> O +i) U d ( 1 1 a <br /> Project Manager Client Project ID (#)&t IMO 10�, 6103 � �� 2 IN <br /> s i I+-+ <br /> W a t I I I z In 1�1 0 M1 a v <br /> attest that the proper field sampling Sampler Name(Print) a Iy _ IyQI C I I I l M <br /> O I I IA I I R J J N j -J Nj <br /> , N rWprocedures were used during the 01 1 m <br /> collection of these samples a l f[`� ; o N N o0. <br /> ¢ 1 I <br /> 01 m +s �' N m a m m 11 m (V I 1 ° O U L <br /> Matrix Method Sampling o 1 I o CL a a 0 1 1 1 1 Iy 'I a J g l , LL I <br /> ¢ - Preserved '� w a N 11 W W � "m 1 a <br /> Field GTEL Cz <br /> z u N o 1^1 €t 1 1 11 a a. 1 1 mo a � N W <br /> Sample Lab# a w V g c� " tn o N m ry N o x v m <br /> r m LM1 m r o ¢_ `? 'a a ¢ a u� �' c� m ca co O nl c o <br /> ID ILab Use l O a ¢ D T z y w a a F w `� a o a Ca a a a a- a a~. 0 as a � o <br /> L only / 3 u�i a cJn Cr o s 1 R v Wo oe o r m m x z o F w w w w w w w w w 1-- w U o c� <br /> N 41 1 <br /> ur- 04 -- <br /> r 05 � 15 <br /> _-I -- <br /> Ll I <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS �9 ��� � ,( SAMill`c 0r,I-ric <br /> GTEL Contact Cw4 Sca4 ode Ahn L U 0( <br /> Pnonty(24 hr) �7 4�� (,C /YJ!•1 CO)Expedited(48 hr) O Quote/Contract# QC C19 Cxtf Scqu F FF Jhg � �13 (L f mr� O .i!dG <br /> 7 Busl es D O Confirmation# ►1 73 .`v <br /> Other o� SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> Business Days O PO # <br /> QAIQC Level <br /> Blue 0 CLP❑ Other O FAX[] Work Order# G C <br /> Relinquished by Sample ,Datq Time Received by <br /> CUSTODY9' -?RECORD Relinquished by Date Time Received by <br /> V Relinquished by Dale Time Received by Laboratory <br /> Z Z3�g5 Uv '47 1 waybill# <br />