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SMITH <br /> ITH Tr�ECHNOLOGY CORPORATION CHAIN-OF-CUSTODY RECORD (See Reverse for Instructions) <br /> PROJECT NAME <br /> ()i k' �i (3f�� SAMPLERS �`�' � ALA <br /> 2 p RINT) SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> PROJECT NUMBER 0, ` '24 J -614 - 16 i 6 i �"d- DESCRIPTION CODES A Ground Water F od <br /> ( /J SIGN A 40 mI VOA Vial B surface Water G Waste 1 Standard <br /> VU <br /> Jfi+� t 1 C Leachate H slanvspike 2 48 Hour <br /> RECORDER - 1 B Glass Liter E brass Tube <br /> G Plastic 500 ml P Ofher D Rinseate I Other 3 24 Hour <br /> { (SIGN) D Plastic Luer E SmIlSediment 4 Other <br /> m oNUMBER OF ANALYSIS REQUESTED g x LABORATORY USE ONLY <br /> o u CONTAINERS v = L <br /> ANALYTICAL LAB �J I ERV ND ° ' LAB PROJECT NO <br /> �! c :: v V <br /> c � PRESERVATION v �+ U w <br /> d EiR VwS 7 Qcmcix SAMPLE <br /> AVERAGE d = z tra ASSIGNED° CONDITION <br /> a d c E y NOTES BOTTLE <br /> UPON <br /> TEMP COND pH W E ;n i NUMBERSRECEPT <br /> NO ATE TIM SAMP E ID ofTqmy ra <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 _ <br /> 8 _ <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> _15 <br /> 16 — —— <br /> NOTES/MISCELLANEOUS Field/Container Temp eli utshed By`(Sigrlillture Received By (Signature) Date Time <br /> R`elinqutshed y (Signature) Received By (Signature) Date Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Container Sealed with Custody Seat Yes I No❑ <br /> Method of Shipment Description of Other Chains-of-Custody Dispat ed By (Signature2", <br /> Date Time Received for lab By (Signature) Date Time <br /> /f O v r f Transport Container Transported with this <br /> l Chain(by Serial No) l <br /> f i <br /> C) e-42- 7A A _2 �9 61107 1 ,- <br /> Send Lab Results to (Name) J Lf h O MCAY (Check Office Below) Verbals Requested Yes No ❑ <br /> SERIAL NO MOUNTAIN VIEW -441 NORTH WHISMAN ROAD, BLD 23 - MTN VIEW, CA 94043 -TEL (415) 960-1640 - FAX (415) 960-0739 <br /> 2 2 PLEASANTON - 7901 STONERIDGE DRIVE, SUITE 100- PLEASANTON, CA 94588 e TEL (510) 463-9117 - FAX (510) 463-2981 <br /> ❑ OTHER TEL FAX <br /> r �■wr r wield Go YE` � Phorato5 <br />