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\ <br /> LWESITONAnalytics Use Only Custody Transfer Record/Lab Work Request <br /> .. .. <br /> I f <br /> W Refri erator# }z'� Use Only <br /> e OAnalytics <br /> nly <br /> t , <br /> #lType Container 7, Samples <br /> Client T� S Volume 1 Shipp dor Han - <br /> Work Order rte' -01- O 1 - OCOO Deliver <br /> r Preservative ti - NOTES: <br /> Date Recd. f j3ol Date Due �Z 1J g� <br /> RFW Contact e0u�3 1--� t MADS ANALYSES 8di5 <br /> ��tt�� REQUESTED 2 Ambi<to ChillClient Contact/Phone 15646of-, 4i#r c NOTES <br /> A Use Only Matrix Date -' <br /> Lab ID Client ID/Description Collected 3 Received Broken/ <br /> O L X Leaking (Improperly <br /> Sealed) <br /> 2- — So v i r� L o %9 X �'� - Y <br /> = NOTES. <br /> J <br /> L_ 4 erty Preserved <br /> Y N <br /> -tdH S: <br /> 5 Received Within <br /> ing Times <br /> Y f1 <br /> -fl@TES <br /> COC Tape Was: <br /> 1 Present on Outer <br /> Package Y N <br /> 2 Unbroken on Outer <br /> PackageY N <br /> 3 Present on Sa <br /> Y N <br /> Metria: W-Wnter DS-Drum Sollds X-Other Special Instructions: FA D�LT-st C-HAIpj Tp 6A" a0iQLAFJ it t_Wbroken on Samp- <br /> S-Soil O Oil DL-Drum Llqulds i` NOTES Y N <br /> SE-Sediment A-Air F-Fish f�UICt CA100LA< P140"I-t+- 465- 3"S <br /> $O-Solid WI-Wipe L- EP/TCLP Leechet• <br /> COC Record Was: <br /> Item/Reason Relin ui ed by Received tilf Date Time Item/Reason Relinquished b Received b Date Time f Present eipt <br /> �( <br /> ,I'm <br /> I; SO of Sa les Y N <br /> Discrepancies Between <br /> Sample Labels and CQC <br /> Record? Y� N <br /> NOTES: <br /> 7 115 <br /> FIFW 21 OOI/A-12/88 <br /> 8911 � 1I7 <br />