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-0 <br /> 4080 PIKE LANE,SUITE C CHAIN-OF-CUSTODY RECORD 31-41 <br /> GTE L CONCORD,CA 94520 AND ANALYSIS REQUEST <br /> (510)685.7852 <br /> [ VIffOYYIMI-1 (800)423-7143 <br /> 1l otmos111 3.0 R <br /> Company Name 6rovJW(Aier c gfhone# �S(a) 671 -2-3fr7 i I <br /> FAX# o W o ❑ d <br /> Sfte <br /> Location 7,uu- <br /> CompanyAddress <br /> � par}-CA"j1.1 �t�I I!'lof f 61u�� aI1/� � rl II II g <br /> i:�KC0(dC� y� Uh CR C/I ` H In a ' <br /> Client Pro ect ip # n Y I 1 <br /> J <br /> Protect Manager 1 �A70Si'!a 1 !fIn <br /> a <br /> ren y w = a <br /> C 1 l lt+l �L°J�C jU <br /> urI o II IE II z z fl " tl <br /> I attest that the proper field sampling Sampler ame(Print) Cr <br /> JK <br /> a o v l J U a 1a 4 � 5 <br /> procedures were used during the /'}'J f C 0 2- 11 g k N io r I a � � X 11 a <br /> collection of these samples `' 44 C2,1J.. a_ a ^ a a � ii ^ r <br /> a ` m N �w a i7 co w 11 II p o v $ 0 <br /> Method Sam lin 0 e a a a L I L I o r N <br /> Matrix � Sampling c� v r1 W e d 11 0. <br /> Field GTEL Preserved L _ t� w Lu -� N N <br /> W r - u o II 11 d <br /> Sample Lab# a �' c 0 a <br /> (p Lab Use It J a ~ a <br /> r m a a a a a a a m <br /> only 3 6 vJi o x O d F m X s o w w w w w w w � w w c� 4 <br /> x <br /> 02 t �. <br /> Wj cv 04 I <br /> I I- <br /> 05 I =]a - <br /> Gt1 I Oro K <br /> wn <br /> : r <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS /,OF I <br /> J <br /> Priority(24 hr) p GTEL Contact <br /> Expedited(48 hr) O Quole/Contract# <br /> 7 taus a Das Confirmation# <br /> Oher SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot A Storago Location <br /> Business Days ❑ PO # <br /> QAIQC Level <br /> Blue O CLP C) other o FAX❑ Work Order#. C-4 c C,p <br /> Relinquished by Sampler fi <br /> ��pate me deceived by <br /> CUSTODY Relinquished by I Date Time Received by <br /> RECORD <br /> Relinquished byDater +Y Time Received by Laboratory <br /> 5��-�►! rl �� f' Waybill# <br />