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CHAIN-OF-CUSTODY RECORD <br /> 1 l 4 � 2 AND ANALYSIS REQUEST 18 7 9 G <br /> >• eo'o ,' ":T, ,Tr 8 7 4 T AVS00 5443422 IN <br /> ( ) ( ) (INSIDE CA) <br /> mpany Name Ph ne N <br /> j-- ❑ o <br /> FAX N ❑ v ❑ <br /> rnpany Address 1 to (A - Dr Site location LI Lj U t,f G �<,tr-V&- %4 F ❑ CI <br /> ma o <br /> y <br /> I ❑ v " ❑ <br /> � D �►-�c.s f s a c r a ri4O © ❑„ '� c A X569 S`i o c.k-i•as <br />)lett Manager Client Project ID (N) 20� J � WWIU v + p U dV a- U <br /> 1 I.�� w Elm cn a5 r cv <br /> �Cj;J q v,iA NAM 6 TkT�—3 o O ❑ ❑ p L] Z z © 0 0 <br /> EJ <br /> Itesl that the proper field s smphng Sampler Name (Priv a ❑ o ❑ o ❑ ❑ E _a O ❑_ <br /> Icedures were used during the collection v <br />,hese samples ry }} ❑ $ a �, o a C- o C, a v ti Q ❑ 0 = <br /> Method N w m La m ¢ W tg U m m O o 0 <br /> Matrix Sampling 23 o V o o Q a ¢ o o ❑ `a_ <br /> Field GTEL a Preserved P T a 0 U w a o- <br /> C1 C) 'Fa ❑ a ”' ❑ <br /> � ❑Sample Lab # w U to ro N a, J <br /> ID (Lab use only) W o o w �� w " o o a a p N <br /> �` g O ¢ D ¢ M v Oz �O w 0. w i- w v o x m a ¢ ¢ ¢ ¢ ¢ a a s ro v o <br /> tia a E- F } — a a Q rz 0. R a a s a_ [� n. <br /> cn ¢ cn a p x x x v oy❑ r- m m s x p w w w w w w w w w w U O U <br /> ill— I - 1° <br /> Mrs — Z z— _ Z0— <br /> DO <br /> —DO <br /> J <br /> - <br /> 71 <br /> �� <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS / <br /> nrily(24 hr) ❑ GIEL Conlact <br /> )edited(48 hr) ❑ 0u0telt;OntraC!M <br /> wsmess Days ❑ Conhrmahon M <br /> PQ a SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot N Storage Location <br /> siness Das ❑ <br /> OA!OC LEVEL <br /> ,jr❑ CLP❑ OTHERFAX❑ Work Order#! <br /> Relinquish y Sampler Ate Time Received by <br /> r/q:�� � 0 <br /> Helm uish b Dale Time Received by j <br /> CUSTODY q y <br /> RECORD rsr linqurshed by Dale TimeRec ed by Laboratory <br /> 11A.yj 131 S v, ()w, igC04 <br /> W iN N <br /> NJ 0 <br /> 781 <br />