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i <br /> . .a FL <br /> I k � <br /> iIIIESTON Analytics Use only <br /> Custody Transfer Record/Lab Work Request _ <br /> Refri erator# WESTON Analy�� � <br /> Use Only <br /> fg o Container - ': <br /> Client Sampes Were: <br /> Volume -- -- A t Shi and- r <br /> Wsik Order r jr <br /> .r _ Preservative - _ f (Deliver rg <br /> Date Rwed. Date Due _ NOTE8; <br /> RFW Contact ANALYSES <br /> Client Gonial VPhona , - REQUESTED w r` 2Ambient°Ch, ed) <br /> NOT i <br /> ' G w` <br /> WA Only Date <br /> Lab M Client ID1Da3cription Matrix Collected 3 Received Broken/ . <br /> rsh�,•r*. 1 - t Leaning(improperly i <br /> �. " Sealed) i 1, <br /> ,,.f ;I, J� i NOTES: <br /> 9.prrip)ly PreservcLd s <br /> �F �•� r l � ,��,,` 5 Received Within ! ;% <br /> ;400th g Times <br /> �} Y•' N <br /> NOTES: <br /> ,I <br /> COC Ta a Was:- tr <br /> I Present on Outer <br /> PackY N <br /> 4 age Y N <br /> 2 Unbroken on Outer <br /> Package Y N <br /> !i <br /> 3 Present on Sample <br /> tak <br /> P <br /> i <br /> strbr: w•wsr DS-Ovum Solidr x-other Special Instructions: _ Unbroken on Sample <br /> S-Sol 0.4U <br /> 11 DL-DrumLiquids � i �': <br /> SE•Sedlmsnt A-Air F-Rsh �� n- t� .. NOTES: Y N <br /> SO-Solid W1=,Wlps L•EPfrCLPUcchste ' <br /> 111mlResson Relinquished by Fecelved by Rate Time� ItomlReason Relinquished by Received b COC Record Was:Dato Time 1 present Upo ljeceipt <br /> of Sample�j N <br /> Discrepancies Between <br /> Sample Labels and C <br /> Record? Y N� <br /> NOTES: <br /> RFW21-21-OOI/A112= 7.115 <br /> I N <br /> i, <br /> k <br />