Laserfiche WebLink
qW 4080 PIKE LANE, SUITE C HAIN-OF-CUSTODY RECORD 4 17 - <br /> 10TEL CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> (510) 685-7852 <br /> 1-110111"I" <br /> Y1110hMfxII (800) 423-7143 ' <br /> Company Name Phone# (9I0 671— �Llf 7 I I <br /> Telu10� C FAX # 4 SC — � I 7,...1 <br /> ICompany Address 4057 P,, kCk, )1,,siteLoca on 2.11 mpf�f ,g/J I I r I 4 1 k l w t;, QCC <br /> O en N L p l I i t <br /> F otect Manager {} Client Prosect ID ( )���0,>Q10�• E�Gr� rt o m In m = o R <br /> �,�fiS UPSc,Gti� _ J13 m ❑ I1 IN II IT z z II fNAEr <br /> � o I I w (o � I I I ! <br /> I attest that the proper field sampling Sampler Name(Print) c a ❑ 13 <br /> d I t I I 0 a a �, <br /> procedures were used during the m "c c� I o p N 1 [ 1 U t N 1 1 0- 0 F <br /> collection of these samples 1 + }a N 2-I # o N Q N 0. h d a z I I `L <br /> Method 10 u M (fin m �¢ m t l w m 1 1 I I o c <br /> Matrix Sampling o P i t ❑ W a a W r] 11 � y l l a C 1 1 <br /> Field GT�t. a Preserved °° r W 0 11 I�CL W m a w 04 <br /> W 1— IN {� U [7 ❑ N tC7 O1 r l 2a, ,. <br /> y, �y Sample La1J# Q W V Cry m !Q O O N N x z[C c7 ¢ a 1n (� (o (� m m ip D ao <br /> ID (Lab Usel o o o o w Wx �" W W � _ IL f! WzQ " = m a a a a aaonly 0 Q o � � 0 r � z � W zle � F h % a O o a a a a a a a F m OO F Co rD I O 1 W W WW W W W W W F- (a <br /> 03 1 <br /> C?4 1 k d Tj <br /> -- <br /> TAT Special Handling <br /> SPECIAL DETECTION LIMITS REMARKS <br /> Priority(24 hr) r 1 GTEL Contact _ <br /> Expedited(48 hr] IQuote/Contract# GIC 94 `t- <br /> 7 Bu sl ess D ys 1 Confirmation 1t!_ __ <br /> Othes9liKDac�a SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> Business Days L I P O # <br /> C_F3 C' <br /> QAIQC Level <br /> Blue L] Ct_r 1 Other I } __— __ FAX� Work Order# � <br /> Relinquished by Sampler Date Time lece aI <br /> CUSTODY slay <br /> Relinquished by Date Time Received y <br /> RECORD -- <br /> Relinquished by Date Time Received by Laboratory <br /> zs M.5 I ob uo Waybill is <br />