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4080 PIKE LANE, SUITE C RAIN--OF-CUSTODY RECORD 'R0323 <br /> ®GTE CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> (510) 685 7852 <br /> (800) 423-7143 <br /> Company Name Phone# q Ito ED) 4100 <br /> 77C] <br /> 61 Yr t FAX ❑ � iI <br /> Company Address Site Location � ❑ 1 0 u ]0 <br /> n n o <br /> [ (K , A� r ,c r t - 1 1 Ln CM ri a ❑ L T-1 <br /> Project Manager Client Project 1D (0)pp�0 0133 ❑ � ❑ a �� <br /> ❑ vi w to til y ¢ F v u <br /> t J n ,, ASN m o O ❑ IN ❑ ❑ z z n ° � ❑ } <br /> 1 attest that the proper field sampling Sampler Name(Print) a- o M ❑ o fl o �] a ,E u N C 3 <br /> procedures were used during the int Y cCG 0 T N ❑ ❑ m a ¢ `? to o <br /> coitect,on of these samples ❑ �' u t Cl a rn o <br /> © 2 w d U '^ o ca < co o ❑ N a ❑ a O c <br /> Matrix <br /> Method Sampling 0 0'U 2 v N ❑ a ¢ U n 00 CD o a J C1 u_ <br /> (^ Preserved n a m ❑ w w tail m -1 � co Cl L] <br /> Field GTEL z ❑ n i m U ❑ ❑ d a L7 g m m ? <br /> Sample Lab # rQ- w v 0 (7 ° `� 0 � � o 0 0 o N N o X � a °' m � <br /> !� rLab Use O 00 0 W p (�_ w tl v (L n �n m �o �a to ,o n O Cv c en <br /> ` z W 4 w n ,� wr w x W o o c a Q <br /> 7 <br /> O = O rca 2 F w w o 'tl T m ¢ ¢ a ¢ ¢ ¢ ¢ a m rn <br /> only u a O m ¢ r V z v za t-$ a � F- T T — a ❑ a a a a a a a a u a a v o <br /> 3 m a to a 0 = x x _ aw Q_ ❑ 4- m m x = O h w w w w w w w w w w U O U <br /> /MW X 3 <br /> I <br /> FFF <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Priority(24 hr) C] GTEL Contact <br /> Expedited(48 hr) ❑ Quote/Contrail <br /> 1 7 Business Days I_I <br /> OtherT <br /> Confirmation# <br /> Other— Days Ci P O � SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot� Storage Location <br /> Business QAIQC Level <br /> ©iue F] CLP f I Other Cl FAX❑ Work Order# <br /> Timiiished y Samp er Rate Time Received 1 <br /> 1 CUSTODY Irl <br /> 'RECORD Relin wished by Date Time Received by <br /> Relinquished by Date Time Received by Laboratory <br /> Waybill# <br />