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4080 PIKE LANE, SUITE C HA IN-OF-CUS TOD Y RECORD 25504 <br /> ' EF CONCORD CA 94520 ND ANALYSIS REQUEST <br /> .,,iGT <br /> 852 <br /> E N V I R O N N E N T A l (51n/V1� 60�-!1 43 <br /> ® IAODRAIORIES, INC. (500 423-7143 <br /> any Name: c _p Phone#: Z ❑ <br /> r\C Dill FAX#: C7 z ❑ <br /> any Address: Site location: <�k rn ❑ ❑ U o El <br /> M T u7 ti <br /> t Manager: Client Project ID: (#) 'jb(�) 0 V d OLLJ •# -+T .. ❑ eo <br /> NAME �13i/t �uc.�! Q o ❑ ❑ ❑ z ❑ <br /> Sampler Name Print ❑ "—� " o °' °E' ❑ <br /> 31 that the proper field sampling P ( ) N ❑ a m ¢ rn o o <br /> duras were used during the collection : ❑ "' ❑ a <br /> ❑ 0 o cn ' a o 0 o 0- vr, � m ❑!se samples. N M � .m v6 m ¢ m ❑ m m ❑ a <br /> Wethod <br /> 12 Matrix Sampling 0 N ❑ ❑ w < w o o ❑ m + <br /> Preserved ❑ <br /> Field GTEL F o ❑ N pa ❑ } <br /> Sample Lab # d � , o x. 8 <br /> W U 0 c? <br /> C a 7. o [� • .CV <br /> I(p Lab Ilse only U. Lj o o w � w x n o °C D Gln n 1- a � a ro o <br /> _ _ O Ea w m ¢ d '¢ ¢ .¢ z�.a :1: <br /> m rn <br /> J O <br /> O J 0 H U OZ Ury W z �a ¢ F �. �, d. f:.1 d 0. 'R. 'd' O_ d ¢ v <br /> n c cn a- 0 2 z x OT o m m x b t- w w w cW w w ,w w u r w U O V <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> xu.y(24 hr) ❑ GTEL Contact <br /> )edued(48 hr) ❑ ouotelContract k <br /> •UsTness Days \ Confirmation ✓f <br /> SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location: <br /> e( PO N <br /> ;mess Das ❑ <br /> OA 1 OC LEVEL <br /> DE❑ CLp❑ OTHER FAX ❑ Work Order # <br /> Relinquished by Sampler: <br /> -� pate Time Received by: <br /> � <br /> CUSTODYRelinquished by: Date Time Received by: <br /> RECORD Relinquished by: Date Time Received by Laboratory: ' <br /> arm_ <br /> Waybill <br />