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MW coNcORDL N,CA io E C ��SL I of Z CHAIN-OF-CUSTODYRECORD 36544 <br /> PGTEL (i10) gS, 7852 AND ANALYSIS REQUEST, •�. .�.„ .� (600) X123 7143 ! 1 <br /> i t <br /> Company Name Phony H s <br /> n-:-1 0rZ � v1� y FAX ff LJ t, I2 fj <br /> Gompany Addre,s 5ile l ocalton m a I I <br /> S F I l E I I 1�V ty c o <br /> 1 Is� Con 1 l w tJ 11 o n N a I II I <br /> roject Man-igrr C icnl Protect ID (ft)ou,-�a�,33 Q � ! • m E 1 a <br /> m M to = <br /> fZ { L m LL L] f1 11 I I i t z m 11 � I l C t t 1�1 <br /> < ar <br /> 1 nitr�i Thal Ihn proprr field snmphnq Sampler ame (Priv) 5 d LN p f_I � 2116 <br /> n t 1 o wf a o m U E 1 <br /> drinnq ltin C ' � � 5z mo m N fy l o n N f t n <br /> procrdwe-wrrp utrd 0 v fl d <br /> collection of Ihesr,snn les �1 ko <br /> 1 1 a <br /> 10 r0 a m r' rn m ¢ m m I I m Nm 11 a O c v n <br /> Matrix Method Sampiing p o 1_, o W a a $ I l I t �� ' a <br /> Preserved co c c E J f t w w ro a -J w w Eq t I {� <br /> Field GTEL -- — — _ — - L} z <br /> -51 <br /> z i- a N o o v o^ o f) { I li a s 11 � 9 w °1 <br /> Sample Lab tt z w V 0 � A `" " o 0 o m N N a x � n °� Y <br /> ID Lab USC Z ¢ o p a w �' v - D ,n ,o ra ,o ,n ro P ro <br /> r z w o ,r, �Wwj <br /> 1 7 O O vI W as TV ~ w to n n i m a a a a a a a a 2 Q <br /> Only U {`� a J rr r u z a =, i o a r- a r a o a a s a a a a a U a ¢ 4m, p <br /> 01 n O r x I _ �� O^ o H m m � z O r w w w w w w w w w F w U � O U — <br /> -�-�_ -- - 01-- - - - - - C- - /� — — -- — -- <br /> _ 2' <br /> y' - w-11- - <br /> 03 3 yx <br /> _ - - - X - - - <br /> W-2, _04- -- - - — -- <br /> W._. 05 <br /> _ <br /> — <br /> ,� _ - 7� - - y - <br /> - - <br /> E 3 �. <br /> q 3 I Z S Ocie In i ,IAL DE TION L fh�LW 1 REMARKS <br /> r'r,onty 126 hr, I IGTEL Contact <br /> Frpndlted 1118 hr] f I Ouole[Conlrncl N _ <br /> 7 811s�r1� l [onhrm 1Uon fl ___ <br /> Other L _ SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot N Slorage Location <br /> Fbisrnnss M%ys ( I P O N Off+ ryry <br /> QAIQC Level <br /> niue I 1 �tFI I t]lt,nr I } —_ FAX❑ Work Order a 0 0 4- <br /> Rrl nshecI Ir+r bale Time Received by <br /> CUSTODY � 3a <br /> "Otnqu, ed by Date Time Received by <br /> RECORD <br /> Relinquished by Dale Time Received by Laboralory <br /> q 17j9 s I U,y C1 Wa bill A l' -y <br />