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A)03)Z, e CZ72A 0 1 . <br /> CHAT -OF-CUSTODY RECORD <br /> e ike Lane AND ANALYSIS REQUEST 72- 13694 CUSTODY RECORD <br /> G cord CA 9 0 800 - 2(In CA) ' <br /> >• °0oaEF`SP1 11A 156 t5say z 4a3 A) ANALYSIS REQUEST <br /> Project Manager Phone# `�l6 "� :'� , ❑ ❑ ❑ <br /> W a m ❑ ❑ _ <br /> •} m N 4b <br /> _r __ } _ 7�s( Q 0 ❑ <br /> _ � FAX# "7�� <br /> Address Site location "' S2 ❑ °+0 _J > <br /> ��'� �� c,� � `� sib) [ I `? �Oc .,h C 1 W p 1 c to uT 2 Q O y <br /> Project Number Protect Name I 2 o m v o y * + O ° U ¢ . <br /> c y <br /> G1C? 3 ❑ o 0 a z zID <br /> — N C3A 4 ❑ <br /> I attest that the proper field sampling Sampler Name(Print) v ° m `-' " N o <br /> procedures were used during the collection ❑ � v m " ° a < N N <br /> of these samples _ _ ce�_�_ , � v _S�> 0 N ° U T ❑ ❑ ❑ ❑ ❑ ❑ Q n o <br /> o ❑ a <br /> Field Source GTEL Q Matrix Method Sampling � `� T co E S N W Q a r, a ❑ d Q ❑ 4J <br /> 0 0 0 it N N a r~ <br /> Sample of Lab# z Preserved ❑ 0 5 b co 0 Y ❑ y ❑ 51 <br /> N 2 a a5 2 ❑ ❑ ❑ ❑ ❑ ❑ 2 - N m T p <br /> Ib Sample ILab a H ¢ W Q o a ❑ - �, N co O v U) v I m -> v v v <br /> only) z C7 ¢ w w m r N a o 0 0 >� N N x a .- y > i i <br /> w ❑ w w LLl x m 3 m cn w ca ca <o O <br /> O l 0 z U) w z = h w Lu z is �v ¢ a a ¢ a a R a ¢ m m` m <br /> # a w O = = 2 U O ~ ¢ F' a ° o o a a a a a a a t� a <br /> z O D F- m m H Q. i.- W W W ul w u r u r w J 0 0 OC a <br /> r� r (V <br /> E E E <br /> SPECIAL HANDLING SPECIAL DETECTION LIMITS(Specify) REMARKS �k <br /> 24 HOURS ❑ E t <br /> EXPEDITED 48 Hours ❑ <br /> SEVEN DAY ❑ n <br /> OTHER (#) BUSINESS DAYS s 4 c <br /> QA/QC CLP Level ❑ Blue Level ❑ SPECIAL REPORTING REQUIREMENTS Lab Use Only Storage Location Cr 1a v <br /> FAX ❑ (Specify) c S E <br /> Lot# Work Order#+: \yv <br /> cc n: ¢ <br />