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4080 PIKE LANE,SUITE C CHAT CUSTODYRECORD 30868 <br /> CONCORD, CA 94520 AND ANAL-YSIS REQUEST <br /> (510)685-7852 <br /> PGTEL <br /> ii�o�e•�oili�yiwG (800)423-7143 ANALYSIS • 1 . .OTHER <br /> Company Name Phone# (510) 671- X18 7 p71 <br /> Gfai �r TCtkKD1&N YACI FAX t! cs WlY$ ❑ _ © ❑ <br /> Company AddressSite Locationy pn,F,t g(.,/ m ❑ ❑ X o <br /> t//}t7� I ?o P ��C"ip �"7 <br /> M'1 It Kra, C l� 3 ❑ EIv a ❑ ❑ <br /> Project Manager ( Client Project ID (#)04�c3�,0 ic�� + b ip ❑' 22 [30 <br /> o ❑ 0 p z co © o 0 <br /> Ct'11�E1 P .KXt j> M r n N ❑ ❑ N E n ❑ o cc <br /> I attest that the proper field sampling Sampler Name(Print) a o "� ❑ $ ❑ o -J - N a ❑ <br /> procedures were used during the �t `} a � ❑ � a N ❑ r3 a a " ❑ a° ~ E ` ru <br /> collection of these samples C1r` 2 +rrr� a a N a a s o <br /> o❑ ` z' Co a ago Wm m VO ❑ oo U g <br /> Matrix Method Sampling $ a d ❑ o W a a ❑ ❑ H ❑ a N ❑ U. <br /> Field GTEL z - Preserved ❑ HV) 4A _ a ❑ o 0 CI d d 0 .9 .00 <br /> ❑ <br /> Sample Lab# a W X 2 N C <br /> IC) Lab USB o �o o W° w w w x a O J a a e ILL <br /> ro 3 m a a a a a a a R in <br /> { y ¢ O $ cn w g6 a " F ; a a a o o a o a a a v a a w <br /> only 3 N a a o a = o v r Cq m 2 2 0 H W W u+ w m w w w u+ H v c� <br /> 3 »�,;r �V <br /> s '�'a' �Y - Irk`K 4 I �.<3x ^e r`" 'f �, ct z <C. ,.nh" ,�3"nc a 'r'''`.,✓` <br /> c d2 u is'00 <br /> s,5x�ra �v k u v»v n 3rr 1 a i a i t GS <br /> 0, J d *" <br /> �+'ent+�Xo ,�,�� i'a <br /> h �a q W, <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Priority(24 hr) ❑ GTEL Contact $�yr, �thg ler./ rc�ft 4650 CG!m+r► L 36 OC- <br /> Expedited <br /> CExpedited(48 hr) ❑ Quote/Contract# 30101 <br /> 7 Business Days 34 Confirmation# <br /> Other SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> Business Days ❑ P O # Z— Ddp'Q <br /> QA/QC Level <br /> Blue❑ CLP❑ other❑ FAX Q Work Order# Z <br /> Relinquished by Sampler �/] ( � pat rime Received by <br /> CUSTODY ,/'�' Io1�9 4, Received b <br /> h r RECORD Relinquished by Date Time y ` <br /> Relinquished by Datp Time Received by Laborptoy r <br /> Waybill# �k �yl� ?�k�'tQl. �f✓ <br />