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T E L 4080-Pike Lane C IN-OF CUSTODY RECORD r, , CUSTODY RECORD <br /> ZIAConcord,CA 94520 800-544-3422(in CA) AND ANALYSIS REQUEST 1 11 1(J 7 <br /> 100 N ME N t A L 415-685-7852 800-423-7143(Outside CA) <br /> 4AGIRA1oRLES INC ANALYSIS REQUEST <br /> J Manager Phone# q ❑ ❑ <br /> w w ❑ ❑ <br /> FAX# _ 0 o m v ❑ <br /> ,dress. *� ocation— `" ❑ - <br /> 1 1 t �/ti E�. co o z ❑ O ❑ c ❑ ❑ y < <br /> �' <br /> m m w a ap = ° `� N p <br /> Project Number Projec Name v ° H + + ° ¢ '' <br /> 2[( -6� S 0 61 J29- yco13 mz ° m ° 9t: 3 <br /> X7.030 �1L _ � � a ❑ ° a a Z = vrn �op ❑ `c <br /> 1 attest that the proper field sampling Sampler Name(Print) N ❑ CM C <br /> procedures were used during the collection J ❑ m � a a N iJ 0 <br /> Ivf�Q! Z� <br /> of these samples fA! N ° a T ❑ ❑ Cl ❑ ❑ ❑ `� ti o i' <br /> a ❑ x rn w <br /> Field Source GTEL Matrix Method Sampling � m E o 0 0 - N N ° q o v ❑ <br /> Sample of Lab# Preserved a a �, 'm 1O a R a ❑ <br /> ID Sample (Lab use a w z " m ❑ ❑ ❑ 0 ❑ ❑ s 2 is <br /> �. W d q — y N aD O V 1n a d <br /> only) 00 _ o W o 0 z W W x cc 3 O a (D (0 m < m m p p� Q ^ w �J i i s <br /> U a p oc rJ Z tN ul O w a a a a a a ra J a a o v v v <br /> 3 rn a rn O z = Z U z O O += m M ti ►°- w w w w Lai, w w LU _j v c) cc <br /> a <br /> -- -- - -- - - -- E E E <br /> lZ <br /> — a o <br /> W' S l <br /> P <br /> SPECIAL HANDLING SPECIAL DETECTION LIMITS(Specify) REMARKS J,^f24 HOURS ❑ E <br /> EXPEDITED 48 Hours ❑ t° <br /> SEVEN DAY ❑ <br /> OTHER---_ (#) BUSINESS DAYS m � L <br /> 0A/0C CLP Level ❑ Blue Levet ❑ SPECIAL REPORTING REQUIREMENTS Lab Use Only Storage Location 5Cr <br /> N 5 <br /> FAx ❑ y _ Q <br /> (Speclf ) Lot# Work Order# �, 4) <br /> cc M cc <br />