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SMITH ENVIRONMENTAL TECHNOLOGIES CORPORATION L;HAIN-OF-CUSTODY RECORD (See Reverse for instructions) <br /> PROJECTNAME Q U&k—S 4yp r3�---- SAMPLERS - i <br /> JPFJ SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> DESCRIPTION CODES A. Ground Water F. oil <br /> PROJECT NUMBER_ y TA. 40-ml VOA Vial B. Surface water G.Waste 1. Standard <br /> (SIGN B, Glass Liter E. Brass Tube C. Leachate N. Blank/Splka 2. 48 Hour <br /> C. Plastic 500-ml F. Other D. Rlnseate I. Other a, 24 Flour <br /> RECORDER . Sol Sediment 4. Olher <br /> ( IGN) D. Ples0c Liter <br /> m 9 Nt1M13ER OF ANALYSIS VESTED Y Y LABORATORY USE ONLY <br /> S °u CONTAINERS o m <br /> ANALYTICAL LAB U �'� <br /> AND u C Y 4 LAB PROJECT NO. <br /> V PRESERVATION e v & eO �/] <br /> Y 2 1 <br /> V <br /> r Z v �� o Ea o m <br /> o w N z v Q 'R a = ASSIGNED SAMPLE <br /> AVERAGE m o a z z ¢ a o CONDITION <br /> a m ti r E } NOTES BOTTLE UPON <br /> TEMP COND pH ' 2 z NUMBERS RECEIPT <br /> N0. DATE TIME SAMPLE Ib •F m�romhoshm "' a k <br /> 1 t2 i�� 13-50 r++1 W` l f _ y 2 <br /> 2 '00 t�=�— <br /> 3 5 �{,W— <br /> 4 .2 1AW D <br /> 5 f fl IJV " <br /> 6 1 $ `8 Qa"' 4 <br /> 7 <br /> 8 <br /> -W�L <br /> g <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> 16 <br /> NOTES/MISCELLANEOUS Field/ContainerTemp. C Eli uishedB;:(S' n re) cely By: (Signature) <br /> Date Time <br /> I wish d By:(Signature)� y Received By. (Signature) Date Time <br /> / f <br /> Relinquished By:(Signature) Received By: (Signature) Date Time <br /> Container Sealed with Custody Seal: Yes ❑ No <br /> Method of Shipment Description of Other Chalns-of-Custody Dispatched By:(Sign ur ) Date Time Received for lab By: (Signature) Date Time <br /> Transport Container Transported with thhiisHH <br /> �L7Ll)6r' VpDI'�, 2x, n(by So <br /> Ns 1d05 t- / J 1d05 <br /> �W� <br /> Send Lab Results to (Name): P,LPiEj 6AP-L-Od (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 /> 20171 ❑ OTHER TEL FAX <br /> _. FSeIdCQp+L YELLOW: P y �: Labo�opy LOTIE9/t35_ <br />