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— <br /> y fN.. �4 -. th-c.,N +w �r rs4w�'. � M !�' ,'�"Ery,..} 'Yr- M- �'[F,.,}HM•- F 'le`°`� <br />�m <br /> ti <br /> i - <br /> Type of Preservation - Print the preservation temperature (e.g., i <br /> t•. �. 4°C), and the preservation chemical (e.g., <br /> " HNO, to pH of 2) <br /> Analysis Required - Print the type of analysis required (e.g., <br /> Total Petroleum Hydrocarbons), or SW <br /> t ' method number(e.g., 418.1) <br /> Relinquished by - Print the name of the person giving up the <br /> sample <br /> Company - Print the Name of the organization giving <br /> up the sample <br /> Date/Time - Print the date and time at which the sample <br /> was given up <br /> Received by - Obtain the signature of the receiving <br /> person <br /> r <br /> zw, <br /> Organization <br /> _ <br /> g Print the name of the receiving <br /> organization <br /> .` Date/Time - Print the date and time at which the sample <br /> was received <br /> Special Shipment/ <br /> Handling/Storage Requirements - Write any appropriate remarks <br /> The completed original chain-of-custody form should be returned promptly to Fmrth <br /> Technology by the laboratory personnel upon initial receipt of the sample and completion of <br /> the form. The original form shall be a permanent part of the project records. Distribution is <br /> as follows: <br /> White Copy' - Project Office file <br /> Canary - Testing laboratory <br /> Pink - Courier or delivery service <br /> Goldenrod - Field file/logbook <br /> 0A91503e101W-OII3 M 12 <br /> L.+ <br /> r <br />