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ij. <br /> IGTEL4080 PIKE <br /> CA 94520 PIKE LANE, SUITE C <br /> CONCHAIN-OF-CUSTODY RECORD <br /> � <br /> (510) 1385-7852 AND ANALYSIS REQUEST 35808 <br /> (800)423-7143 URI i 11, <br /> Company Name: Phone#: -Z {j <.;7 1. 7.2.z I <br /> FAX#: ZL Ut `1- 227_ t f� <br /> Company Address: Site Location: m 0 _ ❑ <br /> I �.( C: �_•,x.} G1it_i 1 2 tttot�E- lr �!� i,zAc.y �� d ~ ° ❑ ❑ CC 0 <br /> ProjectManager; # ❑ � N <br /> I Client Project ID: (#) V a J CI <br /> }'1� a > ❑ o m �, rn cn ° a❑ ~ � '- <br /> NAM +ZAP v �v•! -, s t�,FS[ m o ❑ N❑ ❑ ❑ z z p o Cl <br /> I attest that the proper field sampling Sampler Name(Print): ❑ in <br /> procedures were used during the _ a y a " p p] o 0 0 E �° N p <br /> v> <br /> collection of these samples, Tom.. �- -:TT 12 :� Ar`/ c 0 M r ry ❑ ❑ m a a U o F <br /> °E a N V) a o 0 o a o a v ❑ a ❑ ao <br /> Method - N CQ N a <br /> LL v a ❑ r. <br /> Field Matrix Preserved Sampling N a ❑ o Q a o m El 0' <br /> _J 0 P <br /> GTEL a ❑ a a m ❑ ❑ k p ❑ ri <br /> ❑ ❑ W W OO J J M ❑ <br /> Sample Lab# `¢ U N n° m 0 l❑ ❑ ❑ n- m ❑ g 5 N m ❑>, <br /> ID rLab Usel z W n oTa �_ <br /> x o o ¢ gy m N r, o 5 cn <br /> M J <br /> l / W WO T O O O O N N X 41 <br /> O F- J U W O w W F 9 v1 co �p m �D m (O O g N "c <br /> only U Q O J COL h U f!1 W i¢ _ W W a a b 2 W Q Q Q Q Q Q Q N d Q 2 <br /> VJ Q to a O 2 Z 2 U Sl'MX ONm m = O F W W W W W l�tl W W W H W U O U <br /> �, X 62t�tiZ 4 <br /> f iLi--SP 1- zn o I � <br /> x '.Z5 <br /> 447 <br /> t-?-t 55\Qa 1 I! (, � t 't •IC 1� 1 zj Z-- <br /> .6 :FF <br /> lu <br /> 7 a <br /> _ 1 <br /> 11h'.5�3-ZUf �� I �. $ I <br /> �'� - ��� tN x t. n •v �.+,.l� .1, � t <br /> IC`...�. , f e _�}F i M1..J e#eat i .jA:! p. h..?, •.I R. .yL - _ <br /> TAT Special Handling SPECIAL DETECTION LIMITS <br /> 1 REMARKS: <br /> Priority ((24 hr) ❑ GTEL Contact SA�..] <br /> Expedited 48 hr, ❑ Quote/Contract# <br /> 7 Business Days <br /> Other Confirmation# <br /> Business Days ❑ P.O.# SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot#: Storage Location <br /> QA/QC Level <br /> Blue Cl CLP❑ Other❑ FAX Il Work Order#: <br /> Relinquished by Sampler: Date Time Received by: <br /> CUSTODY -a <br /> RECORD Relinquished by: Date Time Received by: <br /> - ,. l U - - .�.Ufl <br /> Relin wished by: Date Time Received by Laboratory: <br /> t• <br /> Wa bill it <br />