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ao- 66CI <br /> ?, -- �33C-7L/035-Ae�' ► LABORATORY SERVICES CHAIN OF CUSTODY RECORD Lab Number Date (t) 9-c i-A-I <br /> Budget Unit Name&Code 'k- y UVaContact Exlt'� Analysis Required 7 -, <br /> Program Title u 0 .5-Z CA: b� .in n. Program Codes <br /> 5� i 11:.9 34 A '�v <br /> Samoied by =;=portntionMS � 102-OWA [Set�r�I Z1u.k5c n -1'l�v�" <br /> Samole Date Time See Key Lab Type 3 a Station Code No.of Account T P` �► -l�` 7 d 3� l�C <br /> Number Below Sampled Sampled ( ✓ Cont. Codes Q <br /> ; � I <br /> Win <br /> Kei ie� 4�S 3?0� ;c 23 <br /> STc Ico i � �� , ✓ ✓ v/ <br /> 1 I C 57C1 STC KC I I <br /> 1 b�L s'�c�ci <br /> STCKO 'i r f3►-QC STcKC j <br /> STCKC 1 TR k PG C- 5 7 c<C 1 <br /> I CIC ( ( STC K C'1 <br /> 0, 93 cl'k5 <br /> ne r 2-:; ?-:9 St. <br /> 144z svivi <br /> Iaft-w <br /> Signature Print Name Time Date <br /> NOTES: <br /> Relinquished by ,_ r (t) First six digits (YYMMDD) <br /> i (2) Last three digits only. <br /> Received by <br /> (3) Sample type codes: G= Grab. C= Composite <br /> Relinquished by � /l <br /> Sample Matrix Codes: Water,_Waste_water(WW), Tissue,Bay, <br /> Received by , n , Soil,Compost,Sludge,Petrolleum,Other <br /> (4) Check if a foilowup sample. <br /> Relinquished by <br /> (5) Cont. = Containers <br /> Received by <br /> SO 189 7190 AYS <br />