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,CHAIN-OF-CUSTODY RECORD r� <br /> IG <br /> � Cooncnc Pike Laneord,CA 94520 800-544-3422(In CA) AND ANALYSIS REQUEST 72- 5997 CUSTODY RECORD - <br /> c <br /> E N V I R O N M f N 1 A l EL 415 fi85-7852 800-x23-7143{Outside CA) ANALYSIS REQUEST n <br /> flllllllf• LASORATORIFS INC <br /> Project Manager, Phone#: p i ❑WUJ <br /> ❑ ❑ ❑ j <br /> ED l I¢ co w -0 ❑ <br /> ' — - -� ._ FAX#: - - �0 LD a ❑ w <br /> Address: Q Site location: 0 ❑ - ❑ ❑ ❑ ❑ ❑ � ❑ � �' :u � <br /> Can (9a.CJl —_ _ — m m �i °° Il = o `o C"LO z o o a Q <br /> Project Number. Project Name: z N "' v a m N N I{❑ ❑ o ma '� <br /> ❑ 1T <br /> p = U <br /> 1Q0.a - !`- �1C1:rC7 ❑ o ❑ n° C� a z z V �' 0 ❑ c ' <br /> 1 attest that the proper field sampling Samoler Name(Print): - N g y ❑ a o <br /> of <br /> procedures were used during the collection -1 ❑ °' a ao N <br /> of these samples.- C���' f�0 .9 _,^7l/ N 0 �; =l❑ ❑ 11 ❑ ❑ ❑ > , ° (D U. <br /> Matrix Method Sam lin m `O �' M N ° o a ° V ❑ 1d <br /> Field Source GTEL ¢ p m N a m a o o CO a N ❑ a -� <br /> W Ca t6 n N CO co CO CO W 00 � N © N ❑ � T �•. �4.� - +• <br /> Sample of Lab# Z Preserved ❑ c� o ❑ ❑ ❑ n ❑ ❑ b o r <br /> ID Sample (lab use a w 0.0- ❑ -° v Cq m o v In °' 4 v <br /> ~ ¢ C7 ¢ MTn-- <br /> m r m o p a o 0 o - a a 5x c a r .N i <br /> only) Z y� O w w W w X � m n CO m 0 0 CD cn O a O O 3 <br /> a O �, _ F_ ao o a a a a a a a v a uo Q v c°1i <br /> +ncn 0 O D m m H a F- f W W W W w W w F w V U 6 Q Cr f .' <br /> cc <br /> U -Gill, l <br /> E E E <br /> r I <br /> r <br /> , <br /> SPECIAL HANDLING SPECIAL DETECTION LIMITS(Specify) REMARKS: <br /> 24 HOURS ❑ <br /> EXPEDITED 48 Hours ❑ <br /> SEVEN DAY ❑ 1�/ �a�e r o,J a _0 A <br /> OTHER (#) BUSINESS DAYS / V _ L °' <br /> QA/QC CLP Level❑ Blue Level ❑ SPECIAL REPORTING REQUIREMENTS Lab Use Only Storage Location e 3 <br /> FAX ❑ (Specify} Lot#: Work Order#: - <br /> d m a� <br /> cc a: n: <br />