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SMITHPNIIRONMENTAL TECHNOLOGIES CORPORATION CHAIN-OF-CUSTODY RECORD (See Reverse for instructions) <br /> PRO.IECT NAME i�t iTt� _j 10� hf < < <br /> SAMPLERS < 4 J {1 r t <br /> PRI )T� ,� DESCRIPTION CODES <br /> SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> PROJECT NUMBER �� �- `t� �}��, I A Ground Water F of <br /> �y. ��� <br /> y` <br /> (SIGN) A 40 ml VOA Vial B Surface Water G Waste 1 Standard <br /> B Glass C Leachate H Blankly ke 2 48 Hour <br /> 11 16p + C Plas cL500 ml F Other Tube P <br /> RECORDER ��tiT.'�r�� "'' � � _ D Ponseate I Other 3 24 Hour <br /> k}w . (SIGN) D Plastic Lrter E SOIVSedimenl 4 Other <br /> d NUMBER OF ANALYSIS REQUESTED <br /> v o m x g LABORATORY USE ONLY <br /> o u CONTNNERS u m u <br /> ANALYTICAL LAB \o r-k d AND . a r <br /> c PRESERVATION m 5 LAB PROJECT NO <br /> d " � n v u m ��{ C� 7 <br /> c u �; c$o — 1 C.J v ] t <br /> c ° v v T m d <br /> Ea: <br /> o <br /> o y H z U -' 1 3 Etc° ° s SAMPLE <br /> AVERAGE m o n = _ qt tL m a ASSIGNED <br /> a g Q CL {� r E y NOTES BOTTLE CONDITION <br /> TEMP COND pH E E p �� a in z NUMBERS UPON <br /> NO DATE TIME SAMPLE ID 'F micranhoskm '^ �n Al !� ~ RECEIPT <br /> 1 1 t- �' �C> \r — a ► . ,i 1�Z 1, > > I y ". c ", \ d <br /> 3 k3 t V - 1-5 4. A 0 <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 R IIR u shed 8I}(Signpturey Received By (Signature) Date Time <br /> e it*ished By (Signature) Received By (Signature) Date Time <br /> I <br /> Relinquished By (Signature) Received By (Signature) Data Time <br /> Container Sealed with Custody Seal Yes Non <br /> r) Lo <br /> thod of Shipment Description of Other Chains-of-Custody DI pq ehed By (S gnatur6) Date Time Received for lab By (Signature) Date Time <br /> t)r r (-- Transport Container Transported with this ( (z� _e <br /> f Chain(by Serial No} ,�, <br /> kcg onlce-- 11/0 t✓ rL lr� � - + )azo <br /> Send Lab Resents to (Name) P-4 C 0 (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 /> �❑ PLEASANTON •7901 STONERIDGE DRIVE, SUITE 100 - PLEASANTON, CA 94588 •TEL(510) 463-9117- FAX (510) 463-2981 <br /> 20778 ❑ OTHER TEL FAX <br /> WHITF Fir'Irr r— Vrl 1 Mnr r,--- r-. <br />