Laserfiche WebLink
4080 PIKE LANE, SUITE C AIN-OF-CUSTODY RECORD 12679 <br /> W <br /> MEL <br /> CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> (510) 685-7852 • <br /> • •'""f►i�` (800) 423-7143 + <br /> ..•..,e.,,. <br /> Company Name i cc Phone#„(/15 1e/) <br /> n LGISI a cNoy <br /> `r"- Ik a I l ti l t ImNI UI I IVkII IiaI <br /> 1I iaI¢I <br /> W �C' o 7hL FAX# (!;Io) <br /> Company Address q0p p� O;IC;l 117 Site Location �,q t;I <br /> I <br /> rLlIta-l <br /> `oN O <br /> o 4 aco►CcQ _ + u� a <br /> Project Manager Client Project ID (it)IN;ojolp�, 6� Ll N <br /> L o z z > <br /> I¢6r4►•) m a c <br /> I attest that the proper field sampling Sampler(Jame(Print) Lao o a a g y ' - v ILLL I- <br /> m m?c <br /> procedures were used during the o o m <br /> collection of these samples I m l l O co 2 U m co � wO w <br /> NMethod am litg Co., a m 1I I I I I <br /> U) Matrix Swm 11 ccII w o N M <br /> Q Preserved y <br /> Il 2m aField GTEL o ' a rl 2 - ' <br /> ID <br /> tv O o O <br /> ¢ w o cLeh# � X. CVSample Ia ? D a wo C a <br /> O w te ;Eur w a aab Use WX a1p ' a rn eo <br /> � ww w ww w w O U <br /> a ac z � UDri1y O x Oo ll <br /> 0. <br /> w `I <br /> I- <br /> w <br /> o <br /> TAT Special Handling <br /> SPECIAL DETECTION LIMITS REMARKS !rlofl <br /> Priority(24 hr} ❑ GTEL Contact <br /> Expedited(48 hr) C7 Quote/Contract# <br /> 7 Business Days Confirmation# <br /> Dthe r 14s Cn�rirtc SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot It Storage Location <br /> Business Days ❑ PO # <br /> QA/QC Level Work Order# �j <br /> Blue❑ CLP❑ Other❑ FAX❑ <br /> 04 <br /> Relinquished by Samplery�] ate I� Tim,e�n� Received by <br /> hI CUSTODY Relinquished by <br /> I Dale Time Received by <br /> RECORD <br /> Relinquished by Date Time Received <br /> h z CV Waybill# <br /> INIV7-/_;Y .L'C✓ <br />