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4080 PIKE LANE, SUITE C AIN-OF-CUSTODY RECORD 5 6 <br /> IGTE CONCORD, CA 94520 AND ANALYSIS Rf'QUEST <br /> (510) 685-7852 <br /> $0*At0IFF (800)423-7143 ,.fQllFl IMC ! <br /> Company Name T _ Phone V(600332-3 3z /bn3 <br /> J FAX ft (ffa I) 33� — /bS6 ❑ 7 � t <br /> Company Address A 7� ,E' Sa Site Location m � ❑ �] T o) <br /> {,-,Yew�l� 7 <br /> 7 S'.-Je-4x.1 Seex.rs/�cx 7pn S CA 2 � ❑ [1 [l � h Ic o <br /> S.-i 1 tlisC C; N Fn N d [) I I ) <br /> Project Manager <br /> hent Project ID <br /> (#) �1 ❑ a N <br /> � N m01-0.2-0 m U m YO <br /> j5lle—e4i E F ~ n <br /> z z (U > [7 I� c <br /> attest that the proper field sampling Sampler Name Pant r ❑ n Cl [l `o �J J1 � 5 0) a 1l <br /> I P P P 9 p (Print) l -c�- D- N <br /> procedures were used during the c� " n N f I I I m ¢ a ° o r` c <br /> collection of these sam les 3IL <br /> ❑_ �' l a o o N a a s Cl 1^ a <br /> � Method pNd 6c0 11 R a l l ga > <br /> Matrix Sampling Preserved " W w w °Field G3EL ° ° m a s N <br /> v � � Xto CC O O O <br /> ID Lab Use z Q p rC x O AIJ <br /> n w 0 w w o o c -J0 z $> w w = m ¢ ¢ ¢ ¢ ¢ a O o a )only U a m <br /> m <br /> UJI <br /> w w w w w w w w U m n. uu 0d d <br /> ❑0Sample Lab# Q mp <br /> 1;1 <br /> t� <br /> 01 Sr�o l3f� <br /> 3 � p2 13y <br /> A <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Priority(24 hr) TEL Contact r <br /> Expedited(48 hr) ❑ Quote/Contract# <br /> 7 Business Days ❑ Confirmation#+ <br /> Other SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot n Storage Location <br /> Business Days ❑ P O P <br /> za C <br /> DA/CC Level C,f ee c+ 7/?-v wK t w <br /> Blue❑ CLP❑ Other❑ FA Work Order fl <br /> [Relinquishe� <br /> nquished by Sampler Date Time Received by <br /> CUSTODY --� -1 if�a cax, �� <br /> RECORD tnqutshed by � Date � Time Received <br /> -. <br /> 1 <br /> by DateTime Received by Laboratory <br /> L9/11 Waybill It <br />