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4211 MAY STREET CHAIN-OF-CUSTODY RECORD <br /> WICHITA, KS 67209 <br /> N /GTEL (316) 945-2624 AND ANALYSIS REQUEST " • f��?fir <br /> 1 ENVIRONMENTAL IAEORASORIES INC (8130) 633-7936 <br /> n 'I` <br /> Company dame Phonedx1y rr111�� r <br /> FAX # "/, 37-:7 9 _7�s1/ 9 <br /> Company Addre ( w Q ❑ <br /> ❑sSite Location y c rn,T ❑ <br /> N = ¢ <br /> Project Nanager r F -2 a ❑ `D ❑ <br /> I 9 Client Project ID (ay)l,�r��+d y a o i ❑ + ± n ❑ w 4 <br /> 111,,J7,r-. 1c,� �C- N ° m °N' � civ m m z � ~ h <br /> 1 attest that the proper held sampling Sampler NaTe(Print) r a Q 0 ❑N © a 0 ❑ ❑ co <br /> ❑ ❑ <br /> procedures were used during the / N m o ❑ , w o w e v m V N ❑ <br /> collection at these sam teS �r l�� �/'�� p'�7�9r� # a O ❑ n ❑ o❑ ❑ V o to w ❑ ao i.- <br /> kill r o <br /> Method ° R 4 o p N N ❑ 1� a ❑ ° t <br /> Matrix F3 rn m C3 co W W co U O <br /> Sampling o c7 � o p a a � o ❑ > `s � o ro <br /> _ preserved n ❑ <br /> Field GTEL w LO a N a C7 ❑ a a tl _, Q ❑ d "' ❑ u_ <br /> Z — -- - - f- ❑ = o o Rroi m v ❑ w w oo co v n y ❑ c ❑ <br /> Sample Lab Al a w V C4 p a o N ❑ ❑ ❑ n a ❑ 5 rr m <br /> C' o ro v 'n V N CO v in o w R m <br /> ID (Lab Use 1 p o w O w°w wr uI w x cCD U p ,ten w Qn04 oi O c". <br /> l only I U a o Q h U 0z `n w a� a i- M w w n i m a a a a a a a 4 ¢ a ro ° <br /> „ V z w a I. �, a E] a a a d a EL a a V a a <br /> - 3 us a rn 13 0 z 2 _ a p_ p w m m 2 2 O F w w w w w w w w w w V °i O U <br /> Vol <br /> -1126k II' - <br /> K'---J D- <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Priority(24 hr) 0 GTEL Contact <br /> Expedited(48 hr) ❑ Ouote/Contracl a <br /> 7 Business.Days O <br /> Other Confirmation H <br /> Business Days d PO a .<_ .T(�� SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> ' 0A/QC Level <br /> Blue❑ CLP❑ Other❑ _ FAX❑ Work Order q <br /> Relinquished by Sao er / Date Time Received by <br /> CUSTODY 5����,, r�lf�. �.�«�,.- 7��>/ f�c �' - <br /> RECORD Relinquished b� Date Time Received by <br /> Relinquished by Date Time Received by Laboratory <br /> Waybill N <br />