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' � t� f� f� ttttttttttt� ttttttttttttts <br /> 4080 PIKE LANE, <br /> TEL CONCORD, CA 94520TH C AND ANAL YSIS REQUEST I CHAIN-OF-CUSTODY 2693 <br /> rE¢xl <br /> s x ENVIRONMENTAL (510) 685-7852 <br /> _ LANORATORIES INC (800) 423-7143 ' +t+ <br /> Company Name ! l j + s }, I•.r„}} EL r, a <br /> Phone# <br /> uMJtt -fa,. i�fiti IL FAX# 510 <br /> — �, • xas ❑ k <br /> Company Address ❑ ° <br /> Vd5-1 ^� Site iocation !`� � W ❑ <br /> h ` F � x a ❑ <br /> ❑ ❑ ❑ ❑ ❑ v o <br /> Project Manager r r b M it <br /> I g Client Project ID (#) ,O, <br /> l ❑ 2 <br /> ��3o J� m o 0 � V + � Q © ❑ <br /> NAME ❑ ao m a N 2 <br /> I attest that the proper field sam A cc <br /> hng Sampler Name(Print) r o ¢ ❑ C4 ❑ L] z z ❑ ❑ <br /> Procedures were used during the collection # o v ❑ ❑ o ❑ ❑ D E % ❑ ❑ <br /> of these samples c� , a L) ❑ oa a ¢ rn — <br /> ❑ A <br /> ❑ � o N a t ❑ a q O a <br /> V Matrix M od 8 V) m a $ $ ❑ <br /> Field GTEL Preserved Sampling $ 0 c�' a m ❑ o w ¢ a � ❑ o ..., <br /> Sample Lab # ro ❑ z � ❑ w � � ° 93 1 <br /> oa � o ° 101 <br /> ID (Lab use only) 0 � IoW d a- W` D � � _❑ ❑ ❑ ❑ X �v ° -J <br /> u0i Q IIn o. 0 2 z T U z �N Q _� i- D ? a=a D d d R d a d J <br /> O...O J H W fn a= W W <br /> —2W FV-- W U J O <br /> 4 <br /> -22 <br /> L <br /> 32 <br /> S� z <br /> TAT Special Handling SP CIAL DETECTION LIMITS <br /> REMARKS <br /> Priority(24 hr) ❑ GTEL Contact <br /> Expedited(48 hr) ❑ Quote/Contract# <br /> 7 Business Days ❑ Confirmation 0 <br /> Ocher PO# SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# <br /> Business Das ❑ Storage Location <br /> OA/QC LEVEL <br /> BLUE❑ CLP❑ OTHER <br /> FAX❑ Work Order# <br /> Rehn wished by Sampler Date Time Received by <br /> CUSTODY Relinquished by Date Time Received by <br /> RECORDRelinquished by to Time Received b Laboratory <br /> Il w ]!nl <br />