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4080 PIKE LANE, SUITE C AIN—OF—CUSTODY RECORD Wb321 <br /> IGTEL CONCORD, CA 94520 AND ANALYSIS REQUEST <br /> (510) 685-7852 <br /> (800)423-7143 Alm <br /> ,�.Dt�10.i1f 14C <br /> Company Name Phone# f�,�)a UO <br /> L] <br /> l rr � <br /> (111FAX# p <br /> Company Address Site Location m ❑ C3 C3 L) p CC <br /> 0 of <br /> M N a: <br /> q I ID �ra� 1c,7� U) <br /> 1 1 G { GJ ,`"o„ N a Cl IT <br /> Project M nager Client Protect ID (tt)�In vU�,?3 © + <br /> W = Q F- V U <br /> 1 - r �Lu Q t� t� I� Z Z [) O>fNAMEI rI f y <br /> attest I�at the proper field sampting S mpler Name(Print} ❑ L� D m E m t] o <br /> i, ❑_ <br /> in J <br /> procedures were used during the # o C� O n F1 ❑ � k y LJ �° N P- to <br /> collection of these samples �} - ❑ -- - a o o C:, <br /> a V <br /> ui a <br /> Method o c`0i U °f r' W W ¢ m c o N m o (� 0 g v o <br /> Matrix Sampling a 1 ra ❑ ❑ a a o [� D, ❑ N toILL <br /> cc Preserved <br /> Field GTEL W f = o o m ❑a © W w m a a m Nl m La <br /> Z H o Cl 11 t7 a s El <br /> Sample Lab# a W U �, l�V� � Lr o Q o N N X v � '- <br /> Z w U C} W t+ Ww W W W X 1Z A O C UD Wp d N o <br /> ID Lab Use 1 D F J ❑ U O ¢> X y F W W p a M 2 CD Q Q Q Q Q Q Q to Q J Q C <br /> only I c� d o r� J ¢ ►S- V z `N V z W a r N T — a ❑ a 4 a a a a a a ca 0. a ami o <br /> ac N Q r!1 0. O O-- ❑ i- m m S 2 O F- W W W W W W w W W F w U J O U <br /> L0 I 106A V1 I I L 1+ <br /> -31 <br /> ✓ 164 X <br /> Au) t9C 3 <br /> V �1lll�._�i� 3 <br /> -�1 <br /> MLL I t <br /> TAT Special Handling SPECIAL DETECTION LIMITS ArMARKS <br /> Priority(24 hr) t] GTEL Contact <br /> Expedited(48 hr) Ll Quote/Contract# <br /> 7 Business Days LI Confirmation# <br /> Other— SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> Business Days C-I PO # <br /> QAIQC Level <br /> Blue CI CLP C] Other❑ ' FAX❑ Work Order# <br /> Relinquts dSamp er Date Time Received by <br /> ta-1 ? 95 uv <br /> CUSTODY Relinquishe y Date Time Recetve by <br /> RECORD <br /> Relinquished by FDate Time Received by Laboratory <br /> Wa bill# <br />