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Address - ENVIRONMENT ASSESSORS, INC. <br /> Custody Transfer Record/Lab Work Request �1 � _ 10 _ ( 0 <br /> Retriaeratort I Ii LAB USE ONLY <br /> (D -'/Type Containe- Samples Were <br /> Client - � <br /> Work Order 0 7Volume/ �flS~�l- ���! 1 Sh:ppeo o,Hand <br /> f Preservative I Delivereo <br /> Date Recd Date Due `` ¢"' NOTES <br /> ANALYSES <br /> Client ContacUPhone f a1"wlLz SCL m-- REQUESTED �" c�°02 Ambient or Chilled <br /> P CA NOTES <br /> Client ID/Description Matrix Date <br /> Lab iD Collectea 3 Received Broken. <br /> l3 S c) ! Leaking (Improperly <br /> Sealed) <br /> 3 mw r3 - !a I Y N <br /> NorEs <br /> w 13 _ J2 4 Properly Preserved <br /> a I y N <br /> NOTES <br /> S ti <br /> B Received Within <br /> W /3 -- 3 S I Hold is Times <br /> Y N <br /> NOTES <br /> S-b <br /> COC Tape Was <br /> }I 1 present on Oute <br /> A& w f3 � G n � I I I 0ackage Y N <br /> 1 W13 ' Cs f 2 Unoroken on Outer <br /> package Y N <br /> X1,3 — -70 77 i i3 Present on Sample <br /> Y N <br /> Matrix W Water DS Drum Solids X-Other Special Instructions E( 4 Unbroken on Sample <br /> S-Soli 0-011 DL-Drum Liquids {� C / • <br /> SE Sediment A-Air F Fish l �{ w� Zcr- NOTES Y N <br /> SO-Solid W1-Wipe L- EP/TCLP Leachate <br /> a <br /> Item/Reason Relrn uished by Received by Date Time Item/Reason Relin wshed by Received b Date Time COC Record Was <br /> 1 Present Upon Receipt <br /> l d S i I et Samples Y N <br /> Discrepancies Between <br /> Sampie Lapels and COC <br /> { i Record? Y N <br /> I NOTES <br />