Laserfiche WebLink
r-. 4211 MAY STREET <br /> N GTEL WICHITA KS s7zas CHAIN-OF-CUSTODY RECORD <br /> (316) 945-2624 AND ANALYSIS REQUEST70835 <br /> 1� rNVIR0NMfN1AE IAPODAIT)W1 , ;NC (800) 633 7936 <br /> 1 <br /> Company Name Phone N /7 --?']� <br /> �� 37z- 8 7�/ ❑ ❑ <br /> FAX 11 w 0 cD <br /> ID <br /> Company Address Site Location V SS r e nr 1,o Xy co m = ❑ <br /> CC <br /> ❑ ❑ v <br /> V ❑ ❑ Cr <br /> y <br /> / 1 1 l r/'1 (� fn O V1 1!7 Q. ❑ O <br /> Project Manager Client Protect ID (4)��f y�dy5 ❑ n N `' <br /> a ❑ N N N❑ ± O <br /> 'v,4 A l�r h z 1 a.� ,r- (NAME) ui o o ❑ C] n ❑ z z p ❑ <br /> I attest that the proper field sampling Sampler 7aie(Print) FL ❑ <br /> ❑ V) r" v Q ❑ ❑ m ❑ oprocedures were used during the L �, flw a v, ocollection of(hese sem les 1 �� Sl �✓Jr7 �, •? 3 o0 -e in Cl o p ❑ L) o o ❑ <br /> a a v ti m ❑¢ a N a° <br /> Method a V m c� co m ❑ m Co ❑ a 0 0 ❑U o <br /> Field GTEL w <br /> Matrix preserved Sampling 4 n L Q ❑ o 0 ¢ Q w ❑ d ❑ 7 r ty ❑ <br /> °° T ul d N ❑ d J J f0 ❑ d U_ <br /> _ w w 00 n N ❑ <br /> Z ❑ = O O d ❑ d d y y us N ❑ <br /> Sample Let) # ¢ w U No a a C7 u) N ❑ ❑ ❑ ar a ❑ w rn <br /> N N V N co K N O y 6r V y <br /> ID (Lab Use � uai � �o w � O ww wz w w x � � � c � n' � � w � w � O a � o <br /> ` ff O ~ O 2 O cn W arc *yy F- w W 18 8 1p X m g Q Q ¢ Q Q Q ~ .J 4 � v is <br /> only U ¢ p J cr F U Z N zw a+ �. d d d 0. 0. 0. 0. 0. d 4 U a Q y a' o <br /> N 2 a 0 T z z C] Oy O F m m z z O h w w w w w w w w w i- w U O U <br /> - `U^ � rt) - � - - - - - � 30 — - - - - <br /> TAT } Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Pfiorily(24 hr) ❑ GTEL Contact _ <br /> Expedited(48 hrl O Quole(Contracl N <br /> 7 Business Days CI <br /> Other_ - __ _ Confirmation N <br /> Business Days ❑ p Q N ��— ���� SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot N Storage Location <br /> QAJQC Level <br /> Blue❑ CLP❑ Ocher❑ f FAX❑ Work Order N <br /> Rphnquished byY,4vl- <br /> Date Time Received by r1vfiCUSTODY ?fl'7 , ,_�t¢�.r�--- ��>/ � %�'� c_-'G i <br /> Re in wished K. ate Time Received by <br /> RECORD I �, ti iG rlVf, V 'See,✓,Les a, J �ti« �" <br /> Rel,nquishe( by/---) �� / Dat Time Received by Lbboratory /°t/ <br /> 77Wa bill N _}) f ,,r", " I I t <br /> r � <br />