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4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD 1* .� <br /> JJGTh% CONCORD, CA 94520 0 AND ANALYSIS REQUEST 22131 <br /> ENVFRONMENtAL (510) 685-7852 <br /> LA60RATORIE! INC (800) 423-7143 ' i ` t 4 <br /> 19 , ' <br /> ompany Name Phone# 14A fill <br /> FAX# -�7�j ❑ ❑ <br /> ompany Address Site location ,5 ❑ !1 0 ❑ <br /> ( x CD <br /> ❑ ❑ ❑ ❑ Clanal ❑ <br /> rotect ManagerJ Client Project ID (#)p ❑ ❑ L N a ❑ <br /> rr �-32t�iZ 1 w w w ❑ a 11 <br /> 1-� NAME � Moa omM o ~ CE <br /> attest that the proper field sampling Sampler Name(Print) o CV ❑ z z ❑ a ❑ ❑ 1 - <br /> ocedures were used during the collection n " C ❑ ❑ <br /> F L a ❑ ❑ o a v S 0 v <br /> these samples (��] (' a w ❑ Cl m a a <br /> ❑ y LO q o Q N f1U o o ❑ a cin ❑ a <br /> Field Matrix thod Sampling 4 o "' a a CO m o o g <br /> GTEL _ _ F Preserved ❑ = y a N ❑ ❑ o w w ❑ ❑ M ❑ a ❑ <br /> Sample Lab # n a .- ❑ © ❑ a a ❑ g N `) <br /> ID (Lab use only) cc) L`5 oow � � � TQ � � N � X � g, m <br /> at ~ 7 O 2 O O ¢ uN LLI TZ `X e o c - u7 <o ,o m p a m <br /> a o Ir � acro z V, m a �a a �F w v '� x` m a a a a a a a F- ° a ro C <br /> y a cn a O x x x v aN o F= m m i = 0 Lmil w w w w LU <br /> w w w F- w U 3 0 U <br /> -74 <br /> _ z <br /> A <br /> ,t .t <br /> r <br /> 701 1 SV <br /> Z <br /> t Z'1- x tt <br /> 2 <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Wordy(24 hr) ❑ GTEL Contact <br /> cpedited(48 hr) ❑ OuotelContract M <br /> Business Days Y Confirmation# <br /> Fher PON SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> Isiness Das ❑ <br /> QA!QG LEVEL <br /> UE❑ CLP❑ f 'OTHER FAX❑ <br /> Work OrdFrit <br /> Relinquished by S pier Date Tire Received <br /> J S I O D i Relinquished b J Date ime Received by <br /> RECORD Relinquished by <br /> 7me Received by Labor tory <br /> ate` <br /> 7191 �. <br /> ——� -Waybill # <br />