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4080 PIKE LANE, SUITE CCHAIN-OF-CUSTODY RECORD <br /> IGAk <br /> CONCORD, CA 94520 IT3 4 018 , <br /> (510) 685 7852 AND ANALYSIS REQUEST <br /> (800) 423 7143 <br /> ILivill" Hill <br /> Company Name Phone # , �,-0) -;L <br /> / FAX N ❑ ❑ 1 ❑ <br /> Company Address Site Location 9#0 i2D ❑ l ❑ 17 a� ❑ <br /> �f - �� r t• �-�1 e ee~�'� 14 x. i�nu+nl CA 5 �1.�-r. , C1� ,� t ❑ Q m ¢ <br /> Project Manager Client Project I (#)��0�-[]1/33 <br /> ❑ `� Vf y N • Q H <br /> rLo_r 5a L Z ;awl w u o ❑ 0 p ❑ z z ip o C] A <br /> A <br /> 1 altesl that the propm field sampling Sampler Name(Print) 4 0 N r_, � ❑ ❑ m © 0 <br /> procedures were used durinq the c v ❑ ❑ ❑ m ¢ ¢ in .2 <br /> collection of(hose sam les �o.-�.-� 3 of © p a m © a in <br /> G r•♦ll�. d a o c C a r` m Q ❑ a <br /> �, Matrix Method Sampling o a o a a a ❑ �_ ❑ <br /> a Preserved 4 m ❑ w a a ❑ ❑ 9 ❑ a ❑� ❑ <br /> Field GTEL w ❑ z c o in ❑ ❑ w w m a a `� m N w ❑ <br /> Sample Lab H w i? ❑_p ❑qy ❑ © m 0 <br /> \ Cr 7 QQ W �6 N N O x m m <br /> ID ILab only <br /> 1 p O J ¢ !— U On Ir F-1 4 w H LU etl m Q ¢ ¢ Q ¢ Q ¢ O J Q O @ <br /> `` 1 °1 w a a o 4 a a a a a n a c� a s m t?' <br /> N ¢ in a O x x x v ay O_ o w m m x 2 p P w w I w I w wl w w w w i- w 0 J O <br /> 17&J X X I <br /> 010- 1 r _ 3 _ /Sia 4 Al 1511 P4 ��, � � � ! � ��t r � • , <br /> iS ; Ix <br /> 1/_ A <br /> Ode �- <br /> ri. - <br /> yin ' a W%� i <br /> ` '� • t ! <br /> vi . 7r r ' �T�� ' 1001*Ilk ; SMP e <br /> r '� q - ` 1 <br /> � <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Priority(24 hr) i t GTEL Conlacl <br /> Expedded(48 hr) I I Ouole/Conlracl H <br /> 7 Business Days l I <br /> OSvc=,. <br /> _,r Confirmation# <br /> Other— <br /> SPECIAL REPORTING REQUIREMENTS Lab Use Only Lo!p Storage Location <br /> D-vys f y PO # <br /> OA/OC Level <br /> Blue I I CLP I I Other i 1 _ FAX❑ Work Order# <br /> Relinquished by Sampler Date Time Received by <br /> CUSTODY <br /> RECORD Relinquished by Date Time Rece-U by <br /> Relinquished by Dale Time Received by Laboratory <br /> Waybill N <br /> i <br />