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GTE 4080 PIKE LANE, SUITE-C GriAIN-Or-tdST&ur RECumi) 2 2 b 0 <br /> CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> INVIRONMENEAI (510) 685-7852 <br /> IASORATORIES. INC. (800) 423-7143 <br /> Company Name: Phone#: ,f-� C,?7/ 2 3'3.7 <br /> FAX#: U Co•��'' `�I f tl rl' C] ° <br /> Company Address: Sit4 - e location: ❑ <br /> �b.5 7 Gh�I ChI�a o �- 3 ° <br /> Project Manag r: Client Project ID: (# p•2,bS`DZ' ❑ "3 "' �., <br /> a ❑ ❑ . <br /> M <br /> ❑ N ± .+.. E ❑ N <br /> ` NAME , t , o v ❑ ❑ ❑ ❑ =O p ❑ ¢ <br /> I attest that the proper eld sampling Sampler Name(Print): o ❑ o rN; g , 'E ❑ ❑ ❑ pt <br /> procedures were used during the collection y t 3 ca o ;� ❑ Ln ❑ o �•/�� <br /> C (7 M �. N ° ❑ m a n b V <br /> of these samples. e. ( a.( ❑ o o cn ° Ln a o C) a t- ❑ a rn Q❑ a <br /> H Matrix Method Sampling & m CO a C. vi ° 2 ❑ <br /> Field GTEL Preserved = c ❑ ❑ o W W I ❑ ❑ CS 11 � ❑ <br /> Sample Lab # = ❑ 2 $ � m � as 1 <br /> N � � ❑ ❑ ❑ � ❑ � � N <br /> ID (Lab use only) 0 W o o Cr w w " c o o F , <br /> 'k a o m z w a �a a a i m a a a a a a a �- °. a b E <br /> 3 rn cc <br /> R rn a O x x = ( M o Co Co = i o - w w w w w w w w w H w 0 °J cg <br /> a-d <br /> a <br /> 2 Lai — <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Priority(24 hr) ❑ GTEL Contact P 0.#— 1 - J P LO-? se-r- � Q�V O <br /> Expedited(48 hr) ❑ Quote/Contract# �✓ J td�J Q ci"� <br /> 7 Business Days ❑ Confirmation N <br /> Other q0q PON SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location: <br /> Business Das rt x Tv )9�3c,y )10'0g'- <br /> QA/QC LEVEL DDE SS tJ(� Ser�aQ �(��"}" I l� VD I Q <br /> BLUE❑ CLP❑ OTHER FAX 3)/Z/ gz Work Order# GTEL O int^da- <br /> Relinquished by Sampler: Date Time Received by: <br /> 3 ' ' v <br /> CUSTODY Reli ished by: D e Time Received by: <br /> RECORDRelinquished by: Date Time Received by Laboratory: <br /> %. <br /> Rev 7/91 Waybill# /2-1 <br />