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I .■r rr 'tqft6T$A 4wAS%8P_SrRrINT. <br /> Custody Transfer Record/Lab Work Request <br /> Retrt eraloN t LAB USE ONLY <br /> -0 gfTyee Container Samples Were <br /> Client Volume t Shipped or Hand <br /> Work Order b l `n Cm <br /> Preservative Delivered <br /> Date Rec'd Date Due NOTES <br /> ANALYSES S� <br /> /�oY udsu Ste[ REQUESTED b�1C 2 Ambient or Chilled <br /> Client CantacVPhone --� ! .� - - GL NOTES <br /> Date <br /> Matrix Client 1DIDescri tion <br /> Lab tD P Collected 3 Received BrokeN <br /> 1 5 fj/ tau �o-(Q"r3 w ✓ Leaking (improperly <br /> Sealed) <br /> Y N <br /> NOTES <br /> 4 Properly Preserved <br /> Y N <br /> NOTES <br /> 5 Received Within <br /> Holding Times <br /> Y N <br /> NOTES <br /> COC Tape Was <br /> I Precent on Cuter <br /> Packaae Y N <br /> 2 Unbroken on Outer <br /> P,gC+aaa 'i N <br /> 3 Precent on Sarnplo <br /> Y N <br /> Matrix W Water DS Drum Solids K othor specini Instructions 4 Unbroken on Simpie <br /> S Soil 0-011 DL Drum Liquids �`�Q NOTES Y N <br /> SE-Sediment A-Air F-Fish /L -,✓ �i '�t�i� <br /> SO Solid Wl Wipe L- EPITCLP Leachate <br /> COG Record Was <br /> ItemlReason Reiin uished by Received by Date Time Item;Reason Relinquished by Received by Date Time t Present Upon Receipt <br /> 6 of Samples Y N <br /> - Discrepancies 6ecween <br /> Sample Labels and COG <br /> Record? Y N <br /> NOTES <br /> 1 <br />