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sole M M M M � I � � � � � <br /> ENVIRONMENTAL ASSESSORS, INC. �( <br /> Custody Transfer Record/Lab Work Request <br /> Refri erator# LAB USE ONLY <br /> vats- _ S I -#/Type Container Samples Were <br /> C(lent Volume <br /> 1 Shipped or Hand <br /> Work order <br /> Preservative Dehverud <br /> Dale Rec d _ Date Due _ NOTES <br /> ANALYSES <br /> Client Contact/PhoneREQUESTED �V at4 2 Ambient or Chilled <br /> w NOTES <br /> Client ID/Description Matrix Date <br /> Lab ID Collected 3 Received Broken! <br /> W 13 Z- Ps V, I Leaking (improperly <br /> ✓ Sealed} <br /> Y N <br /> IN l ✓ NOTES <br /> V, 4 Properly Preserved <br /> S AA2 Y N <br /> / 'C W Z`4 ✓ ✓ NOTES <br /> ,(A W ! -- S ✓ <br /> 5 Received Within <br /> 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-Wdter DS Drum Solids X Other Special Inntrwiom3 .F� Y_ / . 4 Unbroken on Sample <br /> S-Sod O Oil DL Drum Liquids �L �///� �`�� NOTES Y N <br /> SE Sediment A Air F-Fish <br /> SO-Solid Wl Wipe L EPITCLP Leachate <br /> Item[Reason Relinquished by Received by Date Time item/Reason Relinquished by Received b Date Time COC Record Was <br /> i <br /> T l l Present Upon Receipt <br /> d i ;w• v i l i 1.4 k'if tt:L5-t', 1 t of Samples Y N <br /> Discrepancies Between <br /> Sample Labels and COC <br /> Record? Y N <br /> NOTES <br />