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Custody Transfer cord/Lab Work Request <br /> Rein erator# IAB USE ONLY <br /> "�S S <br /> #/Type Container Samples Were <br /> Client Volume 1 Shipped or Hand <br /> Work Order -- <br /> Preservative Delivered <br /> Date Recd Date Due NOTES <br /> ANALYSESC,00v REQUESTED ��� 2 Ambient or Chilled <br /> Client ContacVPhone L c NOTES <br /> Client ID/Description Matrix Date <br /> Lab ID Collected 3 Received Broken/ <br /> Z 3 Leaking (Improperly <br /> Lo 02 — S 5 1 p,a o t/ Seated) <br /> Y N <br /> NOTES <br /> 4 Properly Preserved <br /> Y N <br /> NOTES <br /> Received <br /> 5 Holding Times <br /> Y N <br /> NOTES <br /> I <br /> COC Tape Was <br /> 1 Present on Outer <br /> Package Y N <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 # { ,�' <2r is 7 10 X sTL-C 'Ie" Ql 4 Unbroken on Sample <br /> S S4011 0 Oil DL Drum Liquids Y"`^ CIL,.{ v� � -Fd� r¢� -C-h NOTES Y N <br /> SE Sedlment A Air F Fish <br /> So Solid Wl-Wipe L EPITCLP Leachate ° `� -. l3 f z�,S24�,rG `{'� <br /> COC Record Was <br /> ItemlReason Relin uished by Received bv Date Time Item/Reason Retin uished b Received by Date Time 1 present Upon Receipt <br /> E Id ti }t7 of Samples Y N <br /> Discrepancies Between <br /> Sample Labels and COC <br /> Record'? Y N <br /> NOTES <br /> I <br />