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4080 PIKE LANE, SUITE G CHAIN OF-CUSTODY RECORD <br /> . 1G L (510), 65 7 52 q-s,2o AND ANALYSIS REQUEST 34025 <br /> {510} fil3ri 7f352 <br /> (800) 123 7143 <br /> r <br /> r-ompany Name Phone # <br /> (77-/ l I1 <br /> FAx a <br /> C�pr�aany�A�dd:rrt:S( Site Location /' Jc'zt'iiaJ Px <br /> o <br /> --3a 2 °' 117 <br /> / Imi0 ri11 <br /> Pfirilert Minirr Chrrnt Project 10(`(11�)� �/ �m � + . I I a <br /> 5 TN i+ 7-:>rJ w a o t I 1 i i 1 r l z z 1=1 ° 1 <br /> N <br /> 1 altr5l Thal Ihr prriprr lirltl S-irnplurq Sampler Name(P n1) a 1a �_ t I 1 1 0 <br /> profrdirrrS wren trertl rlunnq Ihr 1 n rd g '' ,y T1:3 n N i 1 I I en a }a- in <br /> C011rCEipn nr 1hr5r S�1n ire l'� �V�/1 'T_[LIQl1 131 �, p 1�I a o N a a a a la 0. n <br /> Method o m '' vi m ¢ coo m 1 1 to to I ' 11 i) <br /> Matrix Sampling �, 4 l l ° W p a g� r I I t a I I i 1 LL <br /> _ �S V I <br /> Field GTEL Z F Preserved - -- 1 1 ej N g l 1 r i 1 1 1 1 a -J ill 1N z <br /> Sample Lab a i7 V o — o m y n vi o 3 S <br /> t 7 tG ¢ w C9 v ¢ > O <br /> ID (t..►h USr!� 2 iu ° ❑ w t' wi w w x sZ c <br /> D o x S 0 '> x r w w v ra m a a a a a a a g a <br /> only �u o � a u z .. zN a r t- t a ❑ 4 a a a a a a s v a a <br /> 3 v, O_ ❑ m m x = O t- w w w __w w w w w w P.- - w c) 11 <br /> 13 17 <br /> - <br /> 3 _ x_5 _ 3 X - x <br /> -- <br /> rs7w !7C i --- 3 <br /> Iq <br /> RL.)- 1 ZD - - - - -- – x — - - <br /> M .2 0 1 — 3 — — — — -- — - -- <br /> •7�" <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Priority(24 hr) GTEL Conlaci -- <br /> E rperided <br /> _Erperided(AB Pit) Gtlole/Conlracl N _ -- <br /> 7 OuSinets Diya Conh,rnalrun M <br /> olhnr ►--.rt - - - <br /> rluc SPECIAL REPORTtIJG REQUIREMENTS Lab Use Only Let 0 Slrrraye 1 otalion <br /> Day-. T'0 <br /> 0A10C Level <br /> riiur I I CLP I 01her E I __ _ FAX 0 Work Order M C <br /> nPlin 01 hed by amplt� bale Time Recei ed y <br /> CUSTODY Reh uishrd by Dale Time Received by <br /> RECORD —?IC 'c <br /> RLllr qurshrd by Dal Time Received by Laboratory <br /> 0 Wa bill# l !� l <br />