|
4080 PIKE LANE, SUITE C HAIN-OF-CUSTODYRECURD
<br /> colvco94520 �j p 71G.TE (510) 685-75-7 85252 AND ANALYSIS REQUEST � l " 8 O
<br /> (800)423-7143 ti
<br /> Company Name: Phone#: z c(
<br /> Cl
<br /> SnY
<br /> FAX#: Zcry 1G -' ZZ.S 91 ❑ m ❑
<br /> Company Address: Site Location: W = a
<br /> m ❑ ❑
<br /> PA-0 �.� y4,�„�s D, e„���}]a eA M1 �, ° ❑ ❑ a i Ir s
<br /> Project Mana er: � + + a D
<br /> ! 9 Client Project ID: (#) �t�13 6 .G t_c t ❑ ❑
<br /> h m (n U) co m a T C) r¢
<br /> —7�-JS �- p ❑ ❑ n ❑ z z p ❑ a,
<br /> I attest that the proper field sampling Sampler Name(Print): ❑ in � ❑ ❑ 0 ❑
<br /> ID
<br /> procedures were used during the L N ❑ v ❑ W ❑ 0 a a a _ � CM
<br /> collection of these samples, a.� L. �� r.��s.�,• ; o o ❑ � ❑ © 0 r ❑ 0- v~i " o
<br /> ❑ a O N a V r v ¢ ❑ a
<br /> Method o °' "' m Q ❑ m cc 11 a 0
<br /> U) Matrix Sampling N 2 v Q a a a Q a o o D 7 J o m
<br /> Preserved N ❑ LL
<br /> Field GTEL Z © a w a N © W w w o El N © ❑
<br /> Sample Lab# a El El 11 El 2
<br /> _
<br /> Cr W U �� O o 2 p f.� LO 'i N a0 v] 4 y
<br /> ID Lab Use z W Q ❑ W a U w W to C7 � i4 a Q �, Q OLO (D O O N N X m C7 U
<br /> Only { O8 a O J Y- U L U.I a¢ F ~ W W 'a - Z m Q Q ¢ a Q Q Q �"' J Q amu',
<br /> rn ¢ m a 0 x x r U S N O, q a~o m = s O r w w w w w w uai u€ w F w U O ci
<br /> t
<br /> A.�}-° .. �;,
<br /> �:. {� U
<br /> � ',g._ °�' 5 •. 3:t`.ilr ' .aY 3.. .�? k. >
<br /> .w.ea�.. .9t> . ,.
<br /> Sv � '
<br /> 'All
<br /> -s 7
<br /> .` ::.%+.,
<br /> .P..M+c t °A. ia` (,� ,-.:5 :,e h
<br /> ..,a .E,4„ ��� F' '3a a r� ! '
<br /> € ti.`: '3a Q r: :,, i a •. :�'a$ stts _j ; + �'r. lad
<br /> - -16-
<br /> .r` .t, - Y. I ��-- l �' y,k.. ,i}. � ,,. :� d-�!: �$ca,ra��° ;�`".fry '�E"" -,t.-r��?a t. ''t._ 'a ,s 1�• a"i� i9imt� '.r -,c .# -a; h:-
<br /> v
<br /> 3
<br /> a
<br /> K
<br /> § •.,�v °b fi',SU, '� " a' a �xf 1r
<br /> :T, .+ .R
<br /> �. .u:tY1x 'gip" 4 a raN'a '.a x _
<br /> all
<br /> :: pd .E YY
<br /> s :. � n '. k -. !.. 3 St'.5 �.:K t ��F- .i3� R'C 24- t'.91' 4. ..�,'.�
<br /> :,-1. .I q"i L'i _� ! -:Fl"e•.X _.r ._ �..Y.. � S. d� .. .' e'J°�: s �.. " �r { gi' ( �,}. -_��r { j..'`.i :�"i N.:. �
<br /> gY �s a,;_,i •r ` ; : 1:.. Y •: {: .„ s . {p. .. y •{ t ,, yYY .is k v 1 a w C,.x, a 9: ! fj 4
<br /> 6 .i 'tad ..4.• .-xu -`-"-a ,.0 F, ✓. S ,�' :�':..r' 2 'd: t �a +ct '> 'a k ,�` - U ':
<br /> ":.r r=ia� t> 'St .f" .k�=t^ w '-r -� s• <a
<br /> 4 s ?;
<br /> .�, s � r xfip r 4;a€ '7.#A Y •r y .
<br /> ..a:.:,."..au-`i• a,,w�:c^nt��.�r,..s..Ata:z.°�_ .mss 9�ist.��tea'. ON�+a
<br /> ARE I � � r.. r°1'.to:�5� ib4'J�-{cmc g$� �!� ��:�.rk-.a:J.�•r�.,t''�'at #G>��.. .a_c.� ���.�n,. :�.z .>a.,:, _,std..> x'§ sg#�'.i �.0',F's:�.,:� �.`.3 �.SI•.
<br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS:
<br /> Priority(24 hr) ❑ GTEL ContactL /�l t]L S •c1�j7 t '. T il"A 5 lF.T i-)t'r1 r
<br /> Expedited(48 hr) ElQuote/Contract#�.y,�c� �
<br /> 7 Business Days ly�
<br /> Other.._�Tt]�_ Confirmation#
<br /> Business Days p P.O. # SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot#: Storage Location
<br /> QA/QC level
<br /> Blue❑ CLP❑ Other L] FAX❑ Work Order#:
<br /> Relinquished I,y_Sampler; Date Time Received by;
<br /> CUSTODY �' h
<br /> RECORD Relin 'shed by: Date Time Received by.
<br /> t.o
<br /> Relinquished by: Dalb Time Received by L ora ry:
<br /> 9' Waybill# / 'n
<br />
|