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4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD <br /> IGTEL CONCORD, CA 94520 <br /> (510)685.7852 AND ANALYSIS REQUEST 371�,O t (846) 423-7143 + 1 • <br /> Company/Name: Phone H:(7/ 37,L 1170A 141 <br /> �7roL4e, YuJr C' c u o� FAX N: t1911,1379. ` 7PI <br /> Compan Ar dress: l�� Site Lac lion; L� 1� = a ❑ <br /> ,voi ,yam �y�f-�r [�lr, sw;tP I$/� 9��e 7t�v�K7ra�s RSP, 0 ❑ <br /> sTb�k 1. c. ra u m y87 <br /> Project <br /> {)� Manager: Client Project ID: (f+) ; ❑ � r •+ 0 CI <br /> L��I�GGi (rccl�G( <br /> 4)a070 -z3? 6S-QS/ w °ro o ❑ © ❑ ° ° a F- ^ ro <br /> attesl that the proper field sampling Sampler Name(Print): o ❑ N rNi g ❑ ❑ E V ❑ ❑ <br /> procedures were used during the / c v N E] ❑ �° a c :9 N a 0 v F3 <br /> collection o1 these sem les. 1/t�( CR-� e I� L� �, a- 9 o - d ; a <br /> a _ nl 2 u o n C7 N N © a D <br /> Matrix Method Sampling o $ d `� a a a a Q °° ❑ � 5 " 8 u <br /> v a v O w <L ❑ ❑ N ❑ <br /> Field GTEL w Preserved C m r CJ ❑ w w a a a a ❑ <br /> Sample Lab a w a ❑ n ❑ ❑ d � N x <br /> ID Lab Use t- rX 0 ¢ rz 8 a7 , o to Np `pA N X w ro <br /> l Z w J ° O w d 'rw W W w. X � � � c � A of r0 to r0 10 9 W D � � N c YI <br /> l onty ¢ o ¢ ¢ i� z C/3 r W a rw- > a ro n a a a a a a as a v ii a d o <br /> ro <br /> s 7r <br /> in 6 W 4 D x x :2 S D- a F m re I X 011 W W I W I w I W W til W W H W u -J D U <br /> 1177 j<ken�yaa �__.._.._ 3 � — �-- � -- � 01 77 <br /> — - — <br /> 05 - - — — — - HOD ; f <br /> Ito <br /> j 1t.G�C <br /> 00 <br /> 09 <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS: 7C— <br /> Priority(24 hr) I I GTEL Contact <br /> Expedited(4a hr) 1-1 Ouole/Contract q <br /> 7 Business Da s 1-1 Confirmation <br /> Olt1ef s �1��" SPECIAL REPORTING nEQUIREMENTS Lab Use Only Lot 11: Stora ©Location <br /> Business Days I.I P•O• 0 — y `3 <br /> OAIQC Level 50C <br /> Blue I I .CLP I I Other L.I _ FAX❑ Work Order R: <br /> Relinquished by Sampler' al Time Receive by: <br /> CUSTODY . s <br /> RECORD Relinquished b �Y to Time Receive by: <br /> �J 2- <br /> �3 <br /> Relinquished by: Dale Time Received by Laboratory: <br /> 05 5 1ZWa bill# <br /> t <br />