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i <br /> SMITH�RONMENTALTECHNOLOGIES CORPORA CHAIN-OF-CUSTODY RECORD (See Reverse uctlons) <br /> PROJECT NAME Q0 t }% sp 3 _ SAMPLERS =CPFACV)i 1� � �A <br /> t) SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> PROJECT NUMBER ' 'Z i + r <br /> DESCRIPTION CODES B s�rlaea water G Waste t standard <br /> SIGN A 40 ml VOA Vlat <br /> B Glass Liter E Brass Tube C Leachate H Blank[Sp¢ke 2 48 Hour <br /> RECORDERC Plastic 500 k F Other O Rmseate I other 3 24}tour <br /> (SIGN) ❑ Plastic Liter E SolVSedimen3 4 Other <br /> o y NUMBER OF ANALYSIS REQUESTED Y ,� LABORATORY USE ONLY <br /> ! 9 e� coNrAiD v : p <br /> ANALYTICAL LAB l/J�L A s m PRESERVATION <br /> ti L) vPRESERVATION9 LAB{/J���i�O�JEC7 NO <br /> c u ffi x�'v <br /> m e S W <br /> Q m z U E ahg ,,, SAMPLE <br /> AVERAGE r s x �1 e a ASSIGNED <br /> CL o c V ¢ £ ° NOTES BOTTLE CONDITION <br /> TEMP COND pH A a ti y z NUMBERS UPON <br /> NO DATE TIME SAMPLE ID °F micromhoskm RECEIPT <br /> rn m <br /> ! 1 -11 0 0P <br /> r 0 V1 ¢ — <br /> 2 a " -7 _ .00 t <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> to <br /> 11 <br /> 12 _ <br /> 13 <br /> 14 <br /> 15 <br /> 16 <br /> NOTES/MISCELLANEOUS Field/ContamerTemp Relin had By 17�g lure Received By (Signature) Date Time <br /> ReIrnqdished By (Signature) Received By (Signature) Date Time <br /> Relinquished By (Signature) Received By (Signature) Date Time <br /> Container Sealed with Custody Seal Yes N❑❑ <br /> Method of Shipment Description of Other Chains-of-Custody ishad Bgn�ure) Date Time Received for lab By (Signature) Dale Time <br /> Transport Container Transported with this <br /> Co <br /> o v r izr, Chain(by Serial No) 9CIZ3 }} NO <br /> z 09 A"2a"2zz-)-1" �171r fll'42' <br /> Send Lab Results to (Name) -+GA �a (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 /> OTHER❑ <br /> PLEASANTON • 7901 STONERIDGE DRIVE:, SUITE 100• PLEASANTON, CA 94588•TEL( 510) 463-9117•FAX (510 ) 463-2981 <br /> 20920 <br />`I WHITE Field Copy YELLOW Project Copy PINK Laboratory Copy REV 9195 <br /> E <br />