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4080 ITE LANE, SUITE C ( GHAIN-OF-CUSTODY RECORD <br /> GTEL CONCOnD CA 94520 AND ANALYSIS REQUEST 37176 <br /> (510) 685 7852 <br /> ..r (800) 423 7143 1 OTHER <br /> i , <br /> Company Name Phone H <br /> Gc�o�• w�c1 �ww FAX a 3 7.2 d''7 ❑ ° , <br /> Company Address Site Location 9/t0 ,,,,m7L�-s - m z aO ❑ <br /> d D ❑ ¢ P <br /> ('rotect Manager _C6ent P lect ID (11)O�_a7a 01 r © •V nV CD CJ y <br /> ,�d'acccy �xzr �- (NAME) �SI'drr�t 3p�> 6Sb w o o ❑ ° ❑ ❑ Z Z a ° ❑ <br /> I 10 <br /> -IIIr51 th-11 thr pinprr hrld sampling Sampler Name(Print) M ❑ ri in ,y r © ❑ ❑ iz <br /> piocedurns v pie used during the ' a b ❑ v U i ❑ o -1 -j p m U i� (� <br /> collection of tt,r5c samples �t�`(.�-L� t� 3 o N ❑_ o n N cm> N ❑ a° m 0 a <br /> CL N a v r. m a <br /> Method { o❑ " 6 � " y m a w � ❑ m m � a n t o � � <br /> Matrix Sampling o o a o Q a a o ❑ > g <br /> Field GTEL Preserved � �, a H ❑ ❑ w 0- w ❑ ❑ F, ❑ a ❑ <br /> -j jm h ❑ v <br /> Sample Lab ? — — r 0 o m ❑_ ❑ ❑ a a ❑ m N ❑ <br /> ID Lab Use z w Up O w wF w C7 c voi IND W m O "' <br /> only / u 4 p ¢ Cl u (n w ac i- w w D p R i m a a a a a a a a R <br /> rn a 0 a 0 2 x x V a�, 0'^ ❑ F- m m S x q ti w w w w w w w w w t- w U O cg <br /> Rz- X y of�r ?C <br /> – - - — � - <br /> -- <br /> air <br /> �3S Ii- <br /> 0111 <br /> z0 04� <br /> Lo <br /> TAT Special Handling SPECIAL DETECT,ON LIMITS REMARKS <br /> rr,wnry 424 hrf I I GTEL Contact <br /> [rprrtdrd(48 hr) ' Ovole/Contract k <br /> Flu,n s�0� <br /> prirr�� Confirmation A <br /> flu-mess t]lys PO y SPECIAL REPORT NG REQUIREMENTS Lab Use Only Lot N Storage Location <br /> OA10C Level Z DJC ¢ <br /> plur CL t5 Dher ' FAX p Work Order u G Sj O <br /> 43 <br /> RelraDate Time Recet by <br /> n , ,hed by Sm <br /> CUSTODY --19-� &) ed <br /> RECORD net `4\ hi'd by Date Time Rece, ed by <br /> Relinquished by Date Time Received by Laboralory <br /> —1z17-9 LIL I A C, p Waybill H L' <br />