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4080 PIKE LANE SUITE C CHAIN-OF-CUSTODY RECORD 32659 <br /> GT E L CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> {510)fi85-7,52 <br /> IMYlIOMMIiN! (800)423-7143 # # I <br /> ll101lOf,11 L 1 1 <br /> Company Name Phone#(Sto) 671- X307 <br /> 7,.<, <br /> 1 co <br /> {� a t►r TCAAJC 1� -FAX# to - I-Ir Compau Address 4vS7PChlf ,,,Y Slte Location �,�,c� M&e%i- Al" m v I r� LD <br /> I 6A 11•ut,4--(a LA r N LD l0 i I V � o <br /> o Cr; 5 a 11 <br /> Project Manager Client Protect ID (#)pcjuj ptp,�.6103 ❑ K z N N QI F u <br /> �6 �l7 us <br /> m UL a n II I I I I z z I$ > ISI ! I nl41 <br /> I attest that the proper field sampling 5ampiet Name(Print) 2 a IN - �_ o r- I I f I w m o C] <br /> O J _J 10 N j ) N <br /> procedures were used during the 1 • 'a�� Y1' ��� ��� 0 - v �1 y ICJ I I I I m Pa- o H I� c <br /> ' + ' J) �I t 11 o a c� N I I 0. N o <br /> collection of these sam les o �' m a o o N ° d o m a I ! a <br /> Method 4 0 " N m Q m I « m II al C7 a <br /> cu <br /> Matrix Sampling m C7 a 1 1 I o w a as o I I I I N I I a N W,, <br /> Field GTEL w Preserved I� z c ro m i l I I w w m a a m v N I� m I J <br /> z H �' I I I I I i a x i l a m J ? a <br /> Sample Lab# 4v'f <br /> p >- ¢ 7 [> ¢_ L7 ° `-' o CQ l9 <br /> ID Lab Use z w p D w p w° ai w w X o c m m m +o w m m b a < c <br /> r o r- O ►- w w v m m a a a a a a a d a m �, <br /> 15- <br /> only O a ¢ v z "' a a F a. — a ❑ a a a o. a a a a v a a d pLU <br /> y s $ vOi a rn a O z X i U `� O_ [] M m m x s O i- w w w w w w w w w i- w U _j O U <br /> a) <br /> IAJF <br /> 1 ra-c� I - - -- - - -- -- - - — - -- <br /> ME <br /> i <br /> IEFF <br /> EEE W17 <br /> - <br /> EFF <br /> F --�-- <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS PD I C� <br /> Priority 124 hr) Li GTEL Contact <br /> Expedited(48 hr) ❑ Quote/Conlract# QC 9!t W 1C <br /> 7 Business Das ❑ Confirmation# <br /> Other l�� <br /> Business Days ❑ P O # SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> 3°G <br /> QA/QC Level <br /> Blue❑ CLP❑ Other❑ FAX❑ Work Order# C4( 1 033 5 <br /> Relinquished by Sampler Date Time Rei,eived by <br /> lln,z 111171711 1!� JJ <br /> CUSTODY <br /> RECORD Relinquished by Date Time Received by <br /> I n Z-- I <br /> Relinquished byat Time Received by ory <br /> 11 I i5f. Waybill# <br /> 1 <br /> Ops -r FAY - R J <br />