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Ask <br /> 4080 PIKE LANE SUITE C RAIN-OF-CUSTODY RECORD <br /> CONCORD, CA 94520 04001 <br /> TE <br /> GTEL (510) 685.7852 AND ANALYSIS REQUEST <br /> (800)423 7143 <br /> Company Name Phone # <br /> FAX # ^CI A <br /> Company Address 1 Site L4xatton y— m tD 4 rl N s o <br /> 4-,1 44�rZ;{,_ ,, M11 N — CJ o o „ <br /> a Y tn <br /> Project Manaqer <br /> Client Project ID (#) �,�-Z 1 r .7 L a Y� <br /> Y '� �� `r,r1 ( 111 NAM �7h C�1W r`,rnrN P 1 m o L ( ' z z x D <br /> N <br /> I attest that 1rie proper Held sampling Sampler Mame(Print) N n ; r o v rt w N <br /> procedures were used during the r" t � � Q LI �' y <br /> Ct L\J C t'} r, �+ N [ �' m 4 4 U O N n c <br /> collection of these samples , c 3 f 4 4 ' g _a � 2 0. o a o a o c � a v' <br /> Method m �, (a v o o (, n o � e z J <br /> 4 f/1 p7 6 W m m - U a <br /> Cn Matrix Sampling g u n a s ' J <br /> Field GTEL Preserver! _ `° <br /> z m c a a m a w w w R aCL r_ ±n � �I <br /> CD <br /> Sample Lab # h w U N m `� tS v n C) G r, o m -' +' f <br /> tL C7 tr c it_ 8 tv7 `° b aC a o O tv nr x �' N u w \' <br /> l� rLab USr?� U a 0 W n a ww w w x x ' c a ca .n w w O c y� <br /> 1l Only q p a ¢ U z +� =w rs ¢ Fw n 4 p 0. 4a a a a 4 a a U 4 ¢ o ` <br /> co a ur a o s s x U ��+ o� m m s� Y o r W m w W 6u ul W of L ru U O C) <br /> 1 } <br /> r 1 1 <br /> rI I Iv I I f I u <br /> Z <br /> I U <br /> N lX I I hsa <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS _ <br /> Pnonty(24 hr) ❑ GTEL Contact (� CAI SZ At/ rN F RUM <br /> Expedited(48 hr) ❑ Ouote/Contract# `{y Do 1�'5� Cri'I ,,�,sAe.1 rl'r <br /> Business Days ❑ <br /> 7 <br /> 7 Bu Confirmation# <br /> Business Days p PO # �FECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> 0A OC Level <br /> Blue 0 CLP❑ Omer C_ 7�-- - FAX�]r ,r Work Order# cso� 2�lV f <br /> Relinquished b�Sampler G7A <br /> t Time Received by <br /> CUSTOD -I_ <br /> �&m <br /> RECORD Relinquished by \, Date Time Received by <br /> G ti <br /> Relinquished by Date Time Reeerved by Laboratory <br /> Wa blll# ✓fes' /" �!.�.`.'.'"�� <br />