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4080 PIKE LANE,SUITE C C -OF-CUSTODYRECORD <br /> (510 685-7852 <br /> CONCORD, CA <br /> 94520 <br /> WA41GTE■ <br /> AN ANALYSIS REQUEST <br /> IFmet-10#181 !MG (800423-7143 <br /> 1 1 • t <br /> Company Name, Phone#. tstd) t;7!`a3g7 <br /> INN IBM <br /> T =fix I <br /> r.Qoi ay 9.+ l� -� o ° <br /> tu ❑ompany AddressX57 �br tie Location. �q /s! /C10 ! O ❑ _ <br /> r <br /> n <br /> dnhrotd- CA- 1&it Ito C4 r E3 ❑ a D $ ❑ <br /> Protect Manager hent Project ID.(#) oy o)Lafo� , Q + p ❑ <br /> ❑ aOr�adi- <br /> o w ❑ ❑ ❑ ❑ z z ❑ D <br /> I attest that the proper Geld sampling ampler Name(Print) p D rn r ❑ ❑ 0 <br /> procedures were used during the + r a ❑ ❑ ❑ a rmn v ❑ <br /> collection of these sam les ' J+1t to 21 O D �' � ❑ a ❑ <br /> a D Q � ❑ t` <br /> Matrix Preserved thod Sampling a m o a w < ❑ o o 0 o o ❑ <br /> Field GTEL w G C r ❑ ❑ w w Q a Gd' m �" r ❑ m O <br /> Sample L.ab# a $ $ ❑ ❑ ❑ m <br /> ID I-ab Use o a uxr �� w _ a <br /> only / u a a .1 cr v z "' w g d F r a 1 aa.. a s a<. a Aa. o. a E' <br /> S ur a v, n d x x z" g §H o o i= ~m m z t'1 w w w w w w w w uu w 1 o c3 <br /> W I 0 a,y l.* 1i Z" s IeZ w 3 r pit T y 33 �1L� l Y'1 1 �f d s Y{ ti lY l t f L S �lT x719 i! t a� <br /> L. <br /> oa I I Dha <br /> QJ r, }t. z wi <br /> w 04 1 'Sti <br /> W <br /> s k <br /> 06 <br /> Q' <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS � aIc f <br /> 7nonry 124 hr) L GTEL Contact <br />_xpediled(48 hr) L] QuolelContract p , 0101- <br />'BusinQss Days f:; Confirmation q <br />'n'ic A] (L.�il.c�c,l <br /> 3 isl�ess Days _ P O SPECIAL REPORTING REOUIREMENTS Lab Use Only Lot u Storage Location <br /> QAIQC Leel <br /> Blue LLP.Z Dther❑ FAXE) Work Order# C-405ozea <br /> Relinquished by Sampler Dalf Time Received by <br /> CUSTODY 9Z% k' "o S` <br /> RECORD Reltnquished by Date Time Received by <br /> -J Relinquished by Date Time Received by Laboratory <br /> 'q/:;s/q4 DS_05 -Waw a ' <br />