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r <br /> 4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD <br /> IGTEL -- CONCORD, CA 94520 AND ANALYSIS REQUEST3 <br /> - - <br /> (510) 685-7852 <br /> 1110 <br /> �•�� (800)423-7143 WIN <br /> 1 1 <br /> Company Name: r Phone 0:0/` 371�1170a <br /> G rOL11.. L, e A o..ol FAX h: i� 37 7P/ ❑ ❑ ❑ <br /> Company A dress:/ SitepLocAlion: m r a [7 <br /> P/01 /��-��Ct f'�f �/. .T,. r�Q ���� I//d ric7r� /C�, t' w 7 0 U 0❑ ❑ 00 <br /> o <br /> ta <br /> Project Manager. Client Project ID: (#) ❑ * a ❑ CJ ❑11 <br /> e>a-07c3 6$~a y N rn rn 0 I- N <br /> altesl that the proper field sampling Sampler Name(Print): o Cl a M n ❑ m .E `a ❑ o <br /> procedures were used during the N m 2 v ❑m m a a rn ? v ❑ <br /> collection of these samples. 6/t k-Ir- G e ; EL <br /> to ❑ 0 - '4 " a ❑ n° +i d 0 <br /> Method t� R LL m C7 (] � O O N N © 0. O ❑ t• <br /> En Matrix Sampling o 0 d �' o a a Q m o ❑ > 6 U 8 b <br /> 11 Preserved m a ❑ w 0. a- is ❑ ❑ M ❑ a a n LL <br /> Field GTEL w ° _ ❑ ❑ w w m ii m N ❑ ❑ <br /> Sample Lab # ¢ w D ¢ rt C7 O " �o 0 o m N N x u <br /> ID Lab Use $ Au p o w W Aux_ w c ¢ w ao m m iG 0 0 M a 'C o <br /> 0 >- D O U w n> _ !- w w w m m ¢ ¢ a ¢ ¢ ¢ a F- , ¢ 2 '0 N <br /> only a N a N n� 0 t T s v jw O e a F m m S 2 O 1a w w w w w w W w W I'_ w U a O U <br /> 1177 jlotZ 0? <br /> p6o' <br /> 041. <br /> oy <br /> q I 3_.Cn1%ri,e- <br /> .103 <br /> - OS Ilvb " ri <br /> _ a 17- <br /> ID C <br /> t1Gr(C <br /> 000 <br /> IG <br /> Oq od�� <br /> ,3. 2 <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS: <br /> Priority(24 hr) f I GTEL Conlact <br /> Expedited(48 hr) 1_I Quole/Contract# <br /> 7 Business Da s I_I Conlirmalion# <br /> Other�wd,{„�,..- SPECIAL REPORTING REQUIREMENTS Lab Use OnlyLot p: Storage Location <br /> Business Days L I P.O # — g <br /> DA/QC Level Svc <br /> Blue[ i CLP r� Other r.1 FAX❑ Work Order#: <br /> Relinquished by Sampler Time Receive b <br /> aty: <br /> CUSTODY -r J <br /> RECORD Relinquished b . �� tie Time Receive by: <br /> z <br /> Relinquished by: IDale Time Received by Laboratory: <br /> 1�s i zc 2 Waybill# <br />