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E!r <br /> 4080 PIKE LANE, SUITE C t - HAIN OF-CUSTODY RECORD 30869 <br /> TEL CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> (510)685-7852 <br /> Ata °"°'"'A' (800)423-7143 <br /> Company Name ``_ Phone# (`,rho) b7)- 3g7 C3GroU Woklir Tecknolt7 FAX# SK7) .S- 11V8 0 ❑ � <br /> ❑ Y <br /> Site Location xdy /noFl >r �1=d r cc C-1 <br /> Q ❑ <br /> W <br /> Company Address L}0pport Cl,i�� ti °' ❑ ❑ <br /> "MAD <br /> m� �Jp/� JQ V ❑ ❑ ❑ y N <br /> Client Protect ID (#)0y��14 6183 3 ± y ❑a F a <br /> Project Manager y u, m m ❑ Q 6 - <br /> ❑ T <br /> ❑ m m m 0 � to <br /> Ckpis of S�l ❑ ❑ cc x <br /> sampler Name Print g © in o C ❑ N ❑ ° <br /> 1 attest that the proper field sampling P ( ) � a M ❑ v ❑ ❑ ❑ ❑ ° a a a N � V c <br /> procedures were used during the Qa C=1 & O ❑ o a N cmi td y ❑ a N p a <br /> collection of these sam les p m N m m m 0 m m ❑ a p o ❑ 8 r <br /> Matrix Method Sampling o 9 6 e ❑ ❑ a ❑ ❑ m © a k ❑ E <br /> c' Preservedco <br /> Meld GTEL z r d r ° ©_ o a a s mco <br /> Sample Lab# a w o `� A "' N � � � x <br /> cc rc O a �i r� m m so O a v <br /> (J y, N N <br /> ID ab Use) z W - o o W° ++� w w x m m ¢ ¢ a a a a a _j a m t <br /> l <br /> only O ~ o a N w a W a N a o CL a a 0. a a a a U a a d E' o <br /> y d r= m m x x O w w w w w w w w w w 0 -5 O U <br /> 3 N a 7— <br /> in a O x r sw O t] r— <br /> r 09 <br /> CRTI <br /> CAT SCAU FFF <br /> t-7 : z <br /> 7�Qk aE crwt {t _uJ .r �CAV <br /> z' F <br /> — <br /> 1TgAU ELF y w r <br /> rY a�. ,,. r' 9-. K r r .� , � "" �` "�. 1t�1 I{'Is'1 s�•„' .r s 'S .'�.. "?4 LEa h�" <br /> `d ,.� �....^` � <br /> s�s v t <br /> TATS°, Special Handling SPECIAL DETECTION LIMITS RE=MARKS P9 <br /> 40f <br /> Pnonty(24 hr) p GTEL Contact CAT SCAV INF 3 hrs C 4015 CLI min <br /> Expedited(48 hr) ❑ Quote/Contract# e 2171 CC mi, <br /> 7 Business Days Confirmation# CAI S(11u F(" S�tS <br /> Other SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> Business Days ❑ P O # <br /> OA/QC Level <br /> 1 <br /> Blue❑ CLP❑ Other❑ FAX❑ Work Order# ` I r�n�� <br /> Relinquished by Sampler ate Time Received by <br /> CUSTODYV Date � Time Received by <br /> RECORD- <br /> Relinquished by � <br /> �ate, <br /> Relinquished by TeW bl I#by Labors o / <br /> r, <br /> r <br />