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MoI <br /> lio <br /> SMITH TECHNOLOGY CORPORATION CHN-OF-CUSTODY RECORD (See Reverse for Instructions) <br /> PROJECTNAME yCv �aP 3Z -- SAMPLERS SZF'iF —E •�LA <br /> (PRI SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> PROJECT NUMBER 54 —' 2--13 0 yR�l/� DESCRIPTION CODES A Ground Water F Oil <br /> A 40 mt VOA Vial B surface water G Waste 1 Standard <br /> �l— ( IGN} C Leachate H Blank/Spike 2 48 Hour <br /> J c B Glass Luer E Brass Tube D Rinseale I Other 3 24 Hour <br /> RECORDER "rTr'9Si� �1 C Plastic 500-ml F Other <br /> j51GN) D Plastic Later E SoiPSedimenl 4 Other <br /> a "BEROF ANALYSIS REQUESTED d t x LABORATORY USE ONLY <br /> u CONTAINERS c c <br /> 1 t b o alvD ,IwE <br /> S " LAB PROJECT NO. <br /> ANALYTIC v PRESERVATION , <br /> UAMEVAY CHA <br /> qa 17 r , — 1. 1 <br /> L ( l�W I rEr—� 0 = SAMPLE <br /> o z d S +9 a ASSIGNED <br /> AVERAGE m z = - a o CONDITION <br /> CL <br /> E a � i ,t E o NOTES BOTTLE UPON <br /> No TE' TIME c SAMPLE ID , : 'F _ mcar�n pH E. <br /> E Iz (� ~ u� z NUMBERS RECEIPT <br /> 1 �.. t ' r' I — 1 <br /> 2 I t- -7 1�Of '7 a U(vt'v A A XXI&Ir� <br /> 3 Itlas. mp— 10 -9111 , <br /> 4 (/ fo i , <br /> 5 ` <br /> 6 <br /> 7 w <br /> 8 1, I <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 ' <br /> 15 <br /> 16 F <br /> NOTES 1 MISCELLANEOUS- Field/ContalnerTemp Re q t ed Bygn re) Received By (Slgnaty e) Date Time <br /> ` r I Reinulshed y (Signature) Received By (Slgnat ) Date Time <br /> 7 II 2 <br /> r r I Relinquished By ( I ature) Received By (Signature) Date Time <br /> Container Sealed with Custody Seat Yes No❑ <br /> Ar- <br /> Method of Shipment Description of Other Chains-of-Custody Dispatched By (Signature) Date Time Recelved,for fab By (Signature) Date Time <br /> Tnspo Container - Transported with this / 2�3.�} , <br /> Chain(by Serial No) z / <br /> ti ' �7Q 1 r <br /> Send Lab Results to (Name) GA"VJ (Check Office Below) Verbals Requested Yes ❑ Na�. <br /> SERIAL NO MOUNTAIN VIEW•441 NORTH WHISMAN ROAD, BLD'23• MTN VIEW, CA 94043 •TEL (415) 960-1640• FAX (415) 960-0739 <br /> 210 C C ❑ PLEASANTON•7901 STONERIDGE DRIVE, SUITE 100• PLEASANTON, CA 94588•TEL (510)463-9117• FAX (510) 463.2981 <br /> G J 5 ❑ OTHER TEL FAX <br /> WHITE Field Copy YELLOW Prolecl Copy PINK Laboratory Copy REV 9195 <br />