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M EWVtMPNMWNA95ERM OM, wt. 917 `r! ) - 11=11 <br /> Ir Custody Transfer Record/Lab Work Request <br /> 7 <br /> Retri erator# LAS USE ONLY <br /> #/Tyee Container Samples Were <br /> Client — �fl 7 -r�_rp --- Volume t Shipped or Hand- <br /> Work Order r Delivered <br /> Preservative NOTES <br /> Date Reed Date Due �2 �� <br /> ANALYSES � <br /> Client ContacVPhone ��w"�- �'"`�� REQUESTED CP (;t I 2 Ambient or Chilled <br /> NOTES <br /> Client!D/Description Matrix Date <br /> Lab ID Collected 3 Received Broken/ <br /> 7� 6 Leakung (Improperly <br /> Sealed <br /> Y N <br /> 3 D NOTES <br /> 4 Properly Preserved <br /> Y N <br /> �0 NOTES <br /> Sa 3 S S Received Within <br /> Molding Times <br /> Y N <br /> Q <br /> NOTES <br /> � �S <br /> COC Tape Was <br /> y t Present on Outer <br /> 6� Package Y N <br /> 2 Unbroken on Outer <br /> r S Package Y N <br /> 3 Present on Sample <br /> Y N <br /> Matrix W Water DS-Drum Solids X Other Special Instructions Z�A 4 Unbroken on Sample <br /> S Soil O Oil DL Drum Liquids ���� NOTES Y <br /> SE Sediment A-Air F Fish df N <br /> SO Solid WI Wipe L EP/TCLP Leachate <br /> Item/Reason Reliqquished by Received by Date Time Item/Reason Relinquished by Received by Date Time COC Record Was <br /> 1 Present Upon Receipt <br /> of Samples Y N <br /> Discrepancies Between <br /> Sample Labels and COC <br /> Record? Y N <br /> NOTES <br />