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4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD 31-4 <br /> GT E L CONCORD,CA 94520 AND ANALYSIS REQUEST <br /> I <br /> (510)685-7852 f ' <br /> I 60WAIG 1117 INCYIMIAC (800)423-7143 1 1 <br /> 1A07A10f <br /> Company Name Phone# �u (p, Z, ❑ 7 <br /> r (+ r AX# VL� W ❑ s <br /> Company Address o <br /> C lent Project ID (#) (� b Q 1 ❑ 2 v y 0 < 9 a <br /> Project Manager 91 (n s O ❑ ,. <br /> "`A ° o ❑ ❑ ❑ ❑ z z ❑ ❑ ❑ � <br /> __) p <br /> ItC` Sampler Name(Print) ° ° �' ❑ ❑ a X <br /> a st that the proper field sampling p a v ❑ ❑ ❑ a `� o <br /> dures were used dunng the C o +✓ ❑ o a 0tion of these samples ❑ �, w m a $ ❑ ❑ 0 g v 5� ❑ <br /> Matrix Method Sampling c� <br /> rn ❑ ❑ a <br /> ' Field GTEL <br /> Preserved ❑ ❑ o w ° 0. a W a a <br /> a ❑ ❑ ❑100 % % ❑ a <br /> Sample Lab# a 0 <br /> h p Cr O ? 2 o w w w m m a a a a a a a °� a <br /> lLab Usel z F ❑ o W g 9 e' <br /> ID only / c� a o W s 3 z `�' 0 o a 9 m x s o s°u w uai w w w w w r w v °� o c3 <br /> y it N Q u? a O X x < � Q; <br /> R <br /> Iii <br /> iigfiFF Y F <br /> M (A <br /> Bins1 <br /> 1 r <br /> tt 0/ <br /> 1 V lJ L� Wal53 ," Mos so <br /> 3 �' <br /> S ,� x �� jix' �" <br /> ^ Sn� yq <br /> � 4 0Q pR =Y'.r <br /> a <br /> {%� �R Y <br /> 4 0 <br /> L - <br /> TAT Special Handling <br /> SPECIAL DETECTION LIMITS REMARKS <br /> Priority(24 hr) ❑ GTEL ContactL) <br /> Expedited(48 hr) 13Quote/Contract# <br /> 7 Business Days ❑ Confirmation# <br /> Other SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> Business Days ❑ PO # <br /> y QkQC Level Work Order# <br /> `3 Blue CLP❑ Other❑ FAX <br /> ate Time 1`140"d by <br /> e <br /> � } lt ishe y Sam � to"V6 r iv <br /> CUSTODY <br /> Re1i qu�5 Dat Time lve <br /> RECORD , ' �(yo kbd 42 DA11 <br /> ate Time Received by Laboratory � <br /> R;eU qts 15—r ti Waybill# ka� <br />