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4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD <br /> CONCORD, CA 84520 AND ANALYSIS REQUEST 37110(510) 685.7852 <br /> IGTEL <br /> (800) 423-7143 <br /> Company Name: Phone N:(7/4)3-7.L 4170 <br /> (7�Ju4+�QtJr C' eG4+� o FAX N: J6 37 - - 7PI (- ❑ e ❑ <br /> I <br /> CompCD <br /> Ac dress: �` t r Site Loc tion: n/� m ; z Q ❑ <br /> �1/0/ /�4.�y�l'�l �/ . )ra 1 f Q I !� 9�/d �+pEn.�rrt le . �' Ll ❑ n u o <br /> Project Manager: Client Project ID: (H) 3 ± + ❑ ¢ f) <br /> 4n L07o -/37 6 Sa'/ Cl N � � rn m a w r" <br /> Brie-"'tq GCtAr-r- w o ❑ ❑ ❑ n Co z ° ❑ <br /> attest that the proper lield sampling Sampler Name(Print): �°– ❑ N m c ❑ ❑ E o ❑ o ¢ <br /> procedures were used during the 5 g v O a © ❑ m° a ¢ rn h fe <br /> caflection of these samples. �/�t<< k a ❑ a '� ❑ a <br /> ❑ m +n N ❑ v ❑ a a0 n n <br /> N It C C N N <br /> U) Matrix Method Sampling o e p o w i a¢. o O C] p a $ ❑ LL <br /> z Preserved m a <br /> Field GTEL w ❑ i - © ❑ w w co a a m is p ❑ <br /> z m of ❑ ❑ ❑ a a 0 m <br /> Sample Lab # ¢ wz (5 (3 N m:3 4r ccrh v 'n ai Ln N ao `v � o m a J S <br /> Ip Lab Use O t o O w s a z F "' w w n v 3 m a a a a a a a R 0- <br /> a Q <br /> onlyty a p rc -J Ir F U z m w W i- a W i- ? a — a 4 <br /> 3 N a <br /> en a O z z � O o F- m m z z O F w w w w w w w w w F- w 0 -J O L) <br /> 1177 Ikarr4loq — <br /> ?1z L !PAS" — — <br /> -- � . _ — — <br /> 1000 <br /> 1H <br /> 0'-+ <br /> °y — <br /> 05 floo <br /> -7 03 Q 1 <br /> L`� r kc,(e U v tY _ <br /> �l Oq e <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS: <br /> Priority(24 hr) Li GTEL Contact <br /> Expedited(48 hr) 1.1 Quote/Conlracl N <br /> 7 hrsinoss 0 s I_I <br /> Ou �AtCnnlnnallon it <br /> ©usimass pays 11 P.O. N <br /> SPECIAL REPORTING REOUIREMEN 1S Lab Use Only Lot N: Storage Location <br /> � <br /> QA/QC Leel S G <br /> Blue I 1 CLP I.J Oiher i-I _ FAX❑ Work Order N: <br /> Relinquished by Sampler al Time_ Receive by: <br /> CUSTODY r to ` <br /> RECORD Relinquishedb . Q r . 1 Time Receive by: <br /> IBJ z �3 <br /> Relinquished by: Date Time I Received by Laboratory: <br /> • 1�S 1�' 1 Wa biil N i <br />