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4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD - 0404151CONCORD,CA 94520 AND ANAL YSIS REQUEST <br /> 151 IGTEL (510)685-7052 + Ito WWII I A <br /> ' <br /> •"��•••,�•�• (800)483-7143 + <br /> Phone 4 <br /> Company Name (91 G) 372- 11700 C <br /> - <br /> FAX I m <br /> ❑ _ = 4 -r <br /> 0 Company Address SAe Location 6 J 1 c)�IAC. f c r � �'�L � � - <br /> 1r1U1 viaii/,wd Drive �J� �l�l�i'Ir �� � � ❑ a ❑ u � r � <br /> ori a a <br /> etc, 1�i4 ,'I. �ar_ratnertto Cil 35591 L T - `� r a <br /> Client Pralecl 1#) (fit) [��.{(� 2 m rn v e r If <br /> Protect Manager tOrP d le in = o C � <br /> u r S I ;F3C Ui m IL Q, ❑ _ _ <br /> a ? a r— <br /> rn Sam ler Name(Pram) g d' o d C C ° a a <br /> rlattes(chat the proper field sampling p r N ❑; N p , aCtedures were used during the ; o ,q, Q g o N u _ wt rction of these sam les a <br /> u N m a m � m 0r a O> o c3 r <br /> Method Sampiing N o ❑ o, w Q =i ❑ 06 7 ,� LL <br /> Matrix n a m as <br /> GTEL Ic <br /> N Preserved ❑ & e_ <br /> c, — ❑ w w' <br /> Field Q <br /> x <br /> ,-In <br /> 0 <br /> a'rKi .3 <br /> Sf0 <br /> 1^r <br /> _ No 01 <br /> Sample Lab 2 0a <br /> Iil <br /> Lu <br /> Lu dID O ` ��1ab Use ( o <br /> r it L til <br /> -7- <br /> IT,only <br /> I wo- <br /> 04 <br /> a Fr-i <br /> sal <br /> S 9 1A r FJ <br /> �� <br /> r 3 <br /> d <br /> t }F <br /> 4 <br /> 1 r i�5 ;r ✓ ;i i - � is r - _ F4 <br /> 1 Y <br /> ' F _ v Pi x <br /> - <br /> -77 <br /> ' •if n �f ` Y 's <br /> 4 . :F ' <br /> r. T <br /> f J <br /> ,; `f>„ f s,- �>3 ;� ,' r ; „> _ •A REMARKS F (4. <br /> TAT Special Handling SPECIAL DETECTION LIMITS pt�� ye ���� ,Q_ <br /> PnWity(24 tu) ❑ GTEL Contact __ — - T �,1,'r` .�f rVr ' I A^ A kj(, 5 <br /> Ejoedted(48 hs j C Ouoia/CoNracl st __ 'J <br /> 7 euslneis Days �'' Confirmation A Storage Loca1'on <br /> Omer SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot M <br /> Bas.neaes pays ❑ P 0 0 <br /> QAIQC Level Work Order a <br /> Blue 1? CLP= Other r FAX❑ <br /> Dale ,T. <br /> b gam er Receives( y n <br /> Rel s [P' l �! <br /> m CUSTODY ReDaie Tome Rei erred <br /> � Snquis d by <br /> RECORD <br /> w Date Time Received by Laboratory <br /> Retingutshed by <br /> waybill A <br /> 0 <br />