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4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD r 314119 <br /> r rrIrYr.O „� CONCORD,CA 94520 4 AND ANALYSIS REQUEST 510}685-7852 <br /> r..rr.. � <br /> 3'.0 <br /> 00 423.7143 IA l <br /> + <br /> Company Name rrVP hone# 6 71 ? 7 ! <br /> h nc FAX# <br /> Co pany Address It- <br /> fork / 3 Y Ite Location ,� �Fit fSj,rI ;' V <br /> 64 <br /> 01)P%(0fJ' 04 Ct6n CM <br /> Protect Manager Client Project Iq (#) I l (1) , i <br /> kt^IJ OrSotrlo NAMo�OSSr c3 m ° a ',' z m �'I ry <br /> H I I rn I I rr l <br /> I attest that the proper field sampling Sampler Name(Print} ii �, �' i k o -j _j <br /> procedures were used during the rM� (/� " `" <br /> collection of these samples r ~z kk ; ° `� I^I a Q Q N a " ` <br /> n <br /> I I w �, g U o o I i nr r 1 Cr <br /> Method N V V v N rfl a 10 m 0 W r11 I r l r6l i <br /> a Matrix Preserved Sampling ° a �, a -J " I i ' ' " I <br /> Field GTEL c w w <br /> w I l m l k 1 1 i t I I a s <br /> Sample Lab# 3 to a m m a a a a oa a 4 o <br /> ID Lab U ) Ww <br /> a _ <br /> 0 z a a0 <br /> w w w J aau <br /> only 8 rO = ?o <br /> 5 <br /> LIS,, EFE03 II 1 11 III 31 <br /> I Yi V' !�' - <br /> - --- - - <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Priority(24hr) r-] GTEL Contact pfsTkn^ IN r` WP ((ui� C CCf"(I, ' "I' <br /> Expedited(48 hr U C rw� 04'-\ u qw1 {1 Wu& &,,1J Y 3 �[�rM. hr v <br /> I Quote/Contract# � .(� ( )� `( <br /> 7 Business Days ❑ Confirmation# S{a✓ k4 F Wh3 rl�N �r.J l ���rhr„ •' S1fi ` <br /> Other SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot N Storagr-I orrilion <br /> Business Days p P 0 # (f"l 0 0 Z1 r Fi Iferf• 17ox '5- <br /> QAIQC Level Work Order# 05v Z Gf( /9/4 Y- D Cori <br /> awe❑ CLP❑ Outer❑ FAX❑ <br /> Relinquished by Sampler patq Time Received by <br /> A-nI2 shf/l/1"r I- is <br /> CUSTODY Relinquished Date Time Received by <br /> RECORD q y <br /> Relinquished byDal` Timrll! t'e Received by Laboratory n o pr cl ' <br /> 5 I� 1`1 I►, i <br /> W! bill# �'t�:'" <br />