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4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD � ,, <br /> G <br /> CONCORD,685 7 52 saszo -- " AND ANALYSIS REOUEST ICY `}� f`� 340261, 1 <br /> (510) 685 7852 <br /> (800) 423 7143 <br /> Company Name Phone # <br /> G f� FAX # ❑ © e ❑ <br /> Company Address Site Location /7 m `m z 1q ❑ <br /> V r77 <br /> 1��T 1-�, (1__r-,O tet]y/ dl l 1 117 3 r r)4-O/� t1 � m ❑ 0 ❑ ❑ t� V O <br /> G rY, Q C c CD <br /> m [C <br /> Project Manager Client Project ID (q) ^1 // 11r,��1 C] # Ll + N P © -J ❑ ❑ <br /> J r inn CsF�r ,r` ►�L. �'� m w_ 5 Cl ❑ p © i CO p ° ❑ '` m <br /> I allwo thal the proper field sampling Sampler Name(Print) o ❑ D n $ ❑ ❑ •+ b ❑ ❑ <br /> CL W m a <br /> procedures were used during the 5 v ❑ p p m a a Sit fl a b <br /> collection of these sam les Q�J , �r� ; p y © a o_ a m p a <br /> cc LL m M V O O p N N ❑ a. < n n <br /> Matrix <br /> Method Sampling o a m o o a- a d o Cl 13 _o o > G <br /> Field GTEL w Preserved O = © O w w a -J Sd `° a p © ❑ <br /> Sample Lab N a w N g ❑_ ❑ ❑ © m m 'M <br /> Er 0 7 Q o fr C7 `° '° v cC 5 N N X m N Y <br /> ID Lash Use o o d = Q o a; zr w w w ti b m a a a a a a a <br /> 1 only a p a ce ¢ r 3 z zW a >- — o. o a a a a a a a a U Q a m o <br /> x = _ a N o_ O m m x x O w w w w w w w w w r- w U a O C? t <br /> Ha } <br /> r <br /> 'jai r 9 1 L. --4 2 ff i A t <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Priority(24 hr) I i GTEL Contact <br /> Expedited(48 hit I ' Ouole/Contraci M t , <br /> 7 Business Days I 1 Confirmation# <br /> Oihr+r Sj—.,it r� f <br /> Business o,ys PO u SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> i <br /> 1 <br /> 0A/0C Level <br /> ptue' i Ctp i I Other I I _ FAX[] Work Order# <br /> i <br /> Relinquished by Sampler Date Time Received by <br /> CUSTODY <br /> RECORD Relinquished by Date Time RecEWbd by i <br /> Relinquished by Dale Time Received by Laboratory •' <br /> Waybill# <br />