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4080 PIKE LANE, SUITE C <br /> GONCORQ, CA 94520 MAIN-OF-CUSTODY RECORD 33556 <br /> GT (510) 685-7852 AND ANALYSIS REQUEST <br /> IMYIP[IMMFNI�I (800) 423-7143 <br /> r�r l♦/ORIICIRIlf IM[ <br /> Company Name Phone# '116 37d-'4700 <br /> FAX# ❑ ❑ -e ❑ <br /> Company Address Site Location r M ¢ ❑ <br /> 9 I i OfZnt ,gyp Q ❑ o <br /> LOS-1 RDRT- CNC t tJ STUctc-R>J � _ ❑ a o t ❑ <br /> Protect Manager f Client Protect ID (#) LO w <br /> OQ-1 } Q ± ± <br /> nZ n ❑ a ❑ <br /> 3C CC �'PL.c-2 SoUT-t� Sricko 0-20GRO °_ ❑ M ❑ Llz Z p ° o <br /> I attest that the proper field sampling Sampler Name(Print) ❑ D ❑ E C ❑ Cr <br /> procedures were used during the �-,�t L tan v T ro Q q in � v ❑ <br /> n f c C9 ❑ ❑ o f n c <br /> collection of theso samples �`�' � 3 0 ❑_ o ❑ a N o <br /> ❑ m m vi U n o o ❑ [�v N ❑ a p ❑ O t <br /> U) Matrix Method Sampling a o W Q a o o ' _ N <br /> Field GTEL z Preserved p = o o a ❑ ❑ w w _J0. a co m o fl O O <br /> Sample Lab# Q w U No m n cS v ❑ ❑ ❑ v ;B ❑ m rn <br /> F' LL d cc �+ O O O O N N X til U 5 <br /> IQ Lab Use1 O F p o w p irw w� w w X v n M to to m m 0 n < N G o <br /> only ) v ¢ p g ti v �z `� v Z �N ¢ F F D >' n o a a Q a a a d a v ¢a a m b1 0 <br /> r x N ¢ rn a 0 X x = �� 0_ p P m m x r 0 F w w w w w w w w w F w 0 .� 0 v <br /> 0 1 X <br /> mW - 9 0-z- 9 1 X ly <br /> +leis <br /> ryy��wrl I 03 P I5 <br /> rnw- 14 I630 <br /> m w- I osPly 1.V <br /> - <br /> �� coli � 15 <br /> n I U <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS . r u <br /> Priority(24 hr) ❑ GTEL Contact �-`J <br /> Expedited(48 hr) ❑ Quote/Contract# <br /> 7 Business Days ❑ Confirmation# <br /> Other <br /> Business Days ❑ P O # SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> QA/QC Level <br /> Blue D CLP D Other❑ FAX[IWork Order# C*1 07 L4 <br /> Relinquis ed y Sampler DaLq <br /> Time Received by <br /> CUSTODYdaw ' z� � <br /> RECORD 6h�a–L— <br /> Re"n <br /> Date Time R slued by <br /> -2 Q 1�.' 0 <br /> RelirRuished by Dto Time Received by Jaboratory <br /> --48 "�`I f ,) A'' Wa bdl# l 7t q f 2 �o <br />