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9- <br /> Custody Transfer Record/Lab Work Request <br /> Ref ri erator4 LAB USE ONLY <br /> /ly-/I"01,4-A <br /> —� C���t_i�G� Vol e Container Samples Were ' <br /> Client - 1 �( �J Volume 1 Shipped or Hand- <br /> Work Order 7 (- o L-O t oofd Delivered <br /> Preservative <br /> Date Recd Date Due NOTES <br /> ANALYSES 2 Ambient or Chilled <br /> Client ContacVPhone- r 02r-W,D✓t_ �Cfr� -- REQUESTED C�� NOTES <br /> Client ID/Description Matrix Date <br /> Broken/Lab 1D Collected 3 Received Broke <br /> 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 /> MOTES <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 �t � aA-,OL, S1 4 Unbroken on Sample <br /> S Soil 0 Oil OL-Drum Liquids _ NOTES Y N <br /> SE-Sediment A Air F Fish <br /> SO-Solid WI Wipe L EPiTCLP Leachate 4-7 <br /> COC Record Was <br /> Item/Reason Relinquished by Received by Date Time Item/Reason Reim uished bv Received by Date Time 1 Present Upon Receipt <br /> of Samples Y N <br /> Discrepancies Between <br /> Sample Labels and COC <br /> Record) Y N <br /> NOTES <br /> I <br />