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4080 PIKE LANE, SUITE C CHAIN OF-CUSTODY RECORD -72683 <br /> GTEL CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> (51D} 685-7852R (BOD}423-7143 1 1 ' I <br /> lA/o RAro.111 IMC <br /> Company Name Phone# 5 it),0 f �Su"7 ❑ <br /> FAX# 0 ❑ _ ❑ ❑ <br /> Company Address Site Location m ; ❑ ❑ X o <br /> L o n of a ❑ ❑ ❑ <br /> Prosect Manager Client Project ID (#bg2020102 6101 3 t m F N '- <br /> ❑ N N © Z Z = O n <br /> G Gk� Aril mLLo ❑ o ❑ o ° ❑ ❑ ir <br /> E attest that the proper field sampling Sampler Name(Pent) a w o m ❑ ❑ o -J m v C] <br /> t A m a a a N 4o <br /> procedures were used during the a aCO <br /> collection of these samples yL � ya N 0 oy m Method o ❑ ❑,. <br /> C3 11 LL <br /> � Matrix Sampling am <br /> Preserved m ,, N N — ❑ w w J J '� H VI ❑ ❑ <br /> Field GTEL z ❑ N v 10 ❑ ❑ ❑ ❑ a ❑ N � i <br /> Sample Lab# a w N D ccb �' `� `° N x 2 co e h <br /> ID L0 Ed <br /> ab Use a F o ima, <br /> �; _ w w w i m a a a a a a a J a R m <br /> I a s "s - a o a 0. a a a a a a U a a p <br /> only # O cc <br /> a ozw oy = m m = x o i- w W w w w w w w W wvJo" 8 - l' a_ <br /> WW�^si..� n.d^�4 R-�a�� �--"d ' � I •ice �„ `�a <br /> xis �'1$d5� �x +� f 2. b{" X4'}1 3 t' t V. r <br /> +�' }W 5S �',, a <br /> �' ':% <br /> L* <br /> ik <br /> - w� it 'se �Ak a <br /> ,au3 s`+v1 r„��s ;oF' " a °'i"� ?•'x r n= x 4 a ri> ud ,9 32tt� F '�fr A "✓ .0 rot Y*' .,E _: <br /> r �� t at "=gym a <br /> ti's"".� ' x ,v u t 'ki�✓z'I` °3 w' �✓�E gr G°jy�e A s <br /> fn <br /> = i k �4 <br /> �.� <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS 6�4/ <br /> Priority(24 hr) ❑ GTEL Contact <br /> Expedited(48 hr) ❑ Quote/Contract# <br /> 7 Business Days ❑ Confirmation# <br /> Other SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> Business Days ❑ P O # YF <br /> QA/QC Leyel <br /> Blue❑ CLP❑ Other❑ f1FAX[] Work Oroer# �� <br /> Re qu shed Sam rn , ate Time Receryby <br /> CUSTODY Re mq ish by ate Time Receive by <br /> �PECORD r �J �+A 2- <br /> Relinquished by ate Time Received by Laborato J <br /> G Waybill# <br />