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Custody Ti ansfer Record/Lab Work Request <br /> ReItiaera IoOr LAB USE ONLY <br /> «IT e Container <br /> --Yp --in - - - - - --- — -- -- — Szrnpirs Wnrn <br /> Client Volump t Shippea Cr Hand <br /> Work OrderPreservative <br /> Detivered <br /> Date Recd Date Due NOTES <br /> ��{..�, S�a_;rr� _ REQUESTED ��i` �° ,, ' nt or Chilled <br /> Client ContactlPhone NOTES <br /> c <br /> Date BS <br /> Lab tD Client ID/Description Matrix Collected � � 3 RecPivpd Broken <br /> J. - c l - o �� `; Leaking (Improperk <br /> Sealed) <br /> Y N <br /> 3 NOTES <br /> 4 Properly Preserved <br /> Y N <br /> S NOTES <br /> 5 Received Kthin <br /> Holdinc Times <br /> — —�— Y N <br /> NOTES <br /> COC Tape Way <br /> 1 preaPnl on Oulpr <br /> - --—-------- --—— -- -- -- - -- -- — Y acx a g e r I j <br /> 2 Unbroken on Outer <br /> Package Y N <br /> 3 Present on Sample <br /> Y N <br /> Matrix W Water DS Drum Solids X other Special Instructions � � 4 Unbroken on Sample <br /> S soli O Oil DL Drum Liquids ~ -fy cJL CQ�►m{�.ti+�t..� L 5 �`�`� /y` S 7�"C_ NOTES Y N <br /> SE Sediment A A'r F FishC� �\ LGA <br /> So Solid Wt Wipe L EP/TCLP Leachate {V) h K _p <br /> COC Record Was <br /> Item/Reason Relinquished by Received b Date Time Item/Reason Relinquished-by Received by Date Time t Present Upon Receipt <br /> e Gt 6uII LL . )0 e i of Samples Y N <br /> Discrepancies BeNveen <br /> Sample Labels and COC <br /> Record? Y N <br /> NOTES <br />