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4 i <br /> qW 40BO PIKE LANE, SUITE C AIN-OF-CUSTODY RECORD 490132 <br /> GTEL CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> (510 685-7852 <br /> I <br /> laa0��Or iiiM I.c 1800 423-7143 , E <br /> Company Name Phone S t 19C-9 _zz? <br /> l r � ❑ <br /> dui vj "!1 P dtip FAX# @ ❑ <br /> Company Address Site Location m w ❑ ❑ <br /> 0 T7 7 M ip 0 -J 0 21 <br /> Protect Manager Client Protect ID (#L41 2 0162670 ❑ � FD 2 m m = o � 5 <br /> C C I�vnr �} ( � moo ❑ ❑ ❑ Zz ❑ � ❑ ❑ <br /> I attest that the proper field sampling Sampler Name(Print) ° ❑ m N ` T © ❑ y e ❑ o <br /> w C1 <br /> procedures were used during the /N a = a v M a N ❑ l7 m " o ^ <br /> collection of these samples � N o o � N ❑ a `� ❑ ° <br /> ❑ 0 d m 2 U In o o ❑ N N ❑ 0. p c ❑ ^ t <br /> Matrix Method Sampling o m e a © CO a a co ° ❑ ' a $ ❑ u- <br /> Preserved m 3 C b ❑ ❑ w Lu M a a ° m ❑ y ❑ <br /> Field GTEL z N H W ❑ ❑ ❑ a ❑ a <br /> Sample Lab# F �� R ;gg a o o m e } <br /> ID (Lab Use O r ❑ 0 w �' p w° ur r w w w b c a igi ea ti a o <br /> l io 3 m 101, a a a a a a a <br /> 0- <br /> only 00 a p ¢ 3 2 � � z T � �� � a � r � a T n. 0 d d 4. a a a a � i a <br /> y a uJ ¢ m a O x z i U �� g— ❑ H m m z s O � w w w w m w w w w F w U 3 O U <br /> P �,. <br /> +-�a <br /> r `� ,° <br /> s '•"'��.� k� a➢.h���' r+ae' h�y.,� NIX� � ',x a � .'rw s,w'3-JR rPP ;aha � �1 res 3 iw- m A a a <br /> a A <br /> MV 1-14 <br /> Z ry •a fro X .� s <br /> � a <br /> y y'•.°" Y�•'dn.5 <zEi9azn -:.x.Er^s i-„ r.+^✓«I d b "°' <br /> nVab`. ee`P cY i°,3§1.',."`&�'fi�e>^�t+Y�so-`,r3r"�. .r�`a`Sfi�.aukx.�r�"s'E#''�"' " ��`F;}.,'�. �T..5"��te$�r'"a"'4�°Y#§`.-$�{iH:V'amvT+ s�t`ZTxa°.�.r.���'-xs`£�'?' 3_', "moxiQ;-L3Y�a4m"F .yam: �•V n 3 w�,aK,A��.",'R�x �:r<,;3?e�`T a y,1 43 k i.,w` nWY <br /> ::-yxe S s <br /> �t�J.aw 1 7.70 a sr <br /> is � <br /> WON, <br /> 3n Y as s s < ! :a E, y. ? <br /> 'a m, � <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Pnonty(24 hr) ❑ GTEL Contact 0 <br /> Expedited(48 hr) ❑ Quote/Contract# 1 OZ. <br /> • 7 Business Pays ❑ Confirmation# <br /> Other SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> Business Days C31 P O # <br /> 41 QAIQC Level C `�O d�[-�`l <br /> Blue El CLP❑ Other❑ FAX❑ Work Order# 1 <br /> Reli fished y Sampler at Time Received by n <br /> A6 SZ6"-, <br /> CUSTODY Aelinq Ase D Time Received by <br /> RECORD <br /> Relinquish d by Date Time Rec ived by Lab m <br /> 2 t< <br /> Waybill# 0 / <br />