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4080 PIKE LANE, SUITE C �5�� 1 0 Z MAIN-OF-CUSTODY RECORD <br /> IGTEL CONCORD, CA 94520 r.. .e... ..i r <br /> (510) 685 7852 AND ANALYSIS REQUEST � 5 4 4 <br /> r..o...o.,ll (800) 4 2 7143 ` <br /> Company Name }� Phone9 7 <br /> fti N��c2 11 { �,.i�M FAX N ❑ <br /> Company AddressSite Location fa d ❑ <br /> m m x <br /> 0 C1 <br /> rl�� 'C` `C[ k� 1CN� l ft 'h�� t � ❑ © d rx 0 r r <br /> 11rolecl Manager J Clienl Pro ect IU (N)pkp �b13� U =' N u ri Cl L I <br /> -� CC ❑ m in m rn ° a i- s <br /> it �`�/1 m Q D ❑ 0 ❑ ❑ 2 Z �� �j f1 �I y <br /> I allesl Ihnl ilia proper field sampling Sampler Name(Print) 11 m �, (} ❑ c ! 1 Q <br /> procedures we,o used dunng tho � N m 0 ❑ UI ❑ o J -1 m U N ( r <br /> collection of Ihese sim ICS VC ` ��LH N ' in a a cn ' <br /> � Q12�� �' � 3 0 4 ❑ Ln o ❑o 0 n a- <br /> a o a <br /> +n Matrix Method Sampling 0 �' o Q 0 m a a a ❑ m m Cl fa] >O <br /> Field GTEL w _ Preserved m ; H a a ❑ W a a ❑ ❑ n '^ L] a N ❑ <br /> Sample Lab ❑ H c c d m (] w to m a a m u m y <br /> r�P Iu to m g ❑ ❑ ❑ a a (1 N m <br /> ID t] Z l3 Z) Cr o [� C7 ro v T O O °' O N N O X d 4 t7 V <br /> (Lab Use p 0 0 w O ww W w w x c a ,n w w w O N N <br /> 1 only 1 0 a O g T z T w z W Q h _T " a o a a n4 a a 4 a a CL <br /> v 4 a m °' o <br /> 3 <br /> in a rn a o z x z v Sul o.. o F <br /> _ : 1 (51 ,1 , w w w w w w w w r w U -j O 0 <br /> r 3 ,`• i r .I, m m <br /> fr' <br /> jIrl '.i 1 V 5 � <br /> .SJ �� i; S: tri {^ �'4� i r� ai' r i ry 'n } Tti� <br /> VV) 7 <br /> � r ,r <br /> }tt r, r;lir'k <br /> .Jll SSR` . Fj rtrr <br /> _ � <br /> W� r} 1 �'lL717•r`71 wt Yw r �+r� �r r •r� �� T�� 7"= 4lSJ rr.';Fk <br /> Z�rak <br /> rr�� 't ,�, r ja• d� 'Ir .4f } ]Tr L t -+r � , � — <br /> }) lSG <br /> , <br /> `��' r I I � �•y rl ' 'r, / � �1 I � 15 ,I'i 41 r+n � 'w� I _ <br /> 'i ' <br /> I <br /> Special-ribQling SXCIAL DEJRCTION LIMq,';, ,, FIEMARKS <br /> Prlonty(24 hr) (-I GTEL Contact V <br /> I•pr+ddod(48 hr) [l OuotelConlract N <br /> 7 Eirrz ne]S]Day s f �- <br /> Oitler� nj[ �' Confirmation <br /> Elusrnass Days Ll PO N SPECIAL REPORTING REQUIREMENTS Lab Use Only Loi N Storage Location <br /> OA/QC Level <br /> Blue 171 ClP n Omar U _ FAX[j Work Order N <br /> flet itshedY <br /> tn er Dale Time Received by <br /> CUSTODY 3a <br /> rzeil j kd by Dale Time Received by <br /> RECORD <br /> 11 <br /> Reltnquis ed by Date Time Received by Laboratory <br /> i � ►�. rl <br /> ` Waybill N <br /> It. <br /> .zo <br />