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CHAIN-OF-CUSTODY RECORD <br /> 4080 PIKE LANE It G�`�, L � CA `� AND ANALYSIS REQNEST 20650 <br /> RNVIRONYSNTAL <br /> LASORATORIES INC 423-714.3 (OUTSIDE CA) .(81XI) 54404n(INSIDE CA) ANALYSIS REQUE§ OTHER , <br /> 3ompany name tt Phone# T10) 71 -2. <br /> F <br /> • t vet? o FAX# © ❑ 13 <br /> areas Site location C3 <br /> �r }}' f x Is., <br /> fowk Pro Manager Client Project ID (#) G Q 0 ❑ ❑ <br /> it 13w <br /> "Tf• NAM 'S T�4 L VV � a ❑ 13o 13z z o > ❑ 15 <br /> I attest that the proper field sampling Sampler Name(Print) ;I f ❑ ❑ ❑ C3 <br /> af�sa were used during the collection `y,�� VA © C3a, CI <br /> Q ❑ <br /> ❑ o <br /> Matrix Method � � � oe ❑ ❑ '` <br /> Preserved Sampling ❑ s ❑ p ❑ o <br /> Field QITEL I ❑ ❑ @� , ❑ ❑ <br /> Sample Lab # ILI ❑ - ❑ 0 o v <br /> ID (Lab use only) 3 8 <br /> w a O z z 9 �il �Li �e3 IL ual uaf Iii �. <br /> 2 <br /> r16 R <br /> IX�y�•yy� L !� <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> PHR�ify,(24 hr) GTEL Contact I J ' ` <br /> Exp�d(tt3 hr} Quote/Contract I f�j <br /> 7 B,) n"Days ❑ CoNiMMIJon d <br /> 0thK PO# SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot OF Storage Location <br /> stN1I Ae ❑ I <br /> OA/OC LEVEL <br /> BLUE CLP❑ OTHER FAX❑ C , Work Order# <br /> Relin fished by Date Tim Received by <br /> Vtj <br /> CUSTODY R quished by Date Time Received by <br /> RECORD Relinquished by Date Time iv <br /> Rev 7191 Waybill#i <br />