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10 .5 0 <br /> CHAIN OF CUSTODY <br /> SAMPLER TOSCO ANALYSES REQUESTED <br /> f/�¢g re c-S TAS'rl 7-1,4AV SIS # 5-9S'6 CITY 57�Gk n TURIN AROUND TIME <br /> WITNESSING AGENCY ADDRESS <br /> SAMPLING � REMARKS <br /> SAMPLE ID NO DATE TIME WATER GRAIL COMP NO OF CONT LOCATION CC <br /> X n5 ZOg <br /> S Z Y Y X 05@209 <br /> cs 3 05 210 <br /> RELINQUISHED BY D fATEITIM-y7E RECEIVED BY DATEITIME THE FOLLOWING MUST BE COMPLETED BY THE LABORATORY ACCEPTING SAMPLES FOR ANALYSES <br /> I HAVE ALL SAMPI CS RECEIVED FOR ANALYSIS BEEN STORED ON ICE? <br /> pit, <br /> (SIGNATURE) / 2 WILL SAMPLES REMAIN REFRIGERATED UNTIL ANALYZED? <br /> #/M Ar., 1Ciy =-zu <br /> (SIGNATURE) ISI N U ) 3 DID ANY SAMPLES RECEIVED FOR ANALYSIS HAVE HEAD SPACE? CNV 1/ <br /> (SIGNATURE) (SIGNATURE) 4 WERE SAMPLES IN APPROPRIATE CONTAINERS AND PROPERLY PACKAGED? [LS <br /> (SIGNATURE) {SIGNATURE) SIGNATURE TITLE DATE <br /> Note All water containers to be sampled for TPHG/BTEX 8010 & 8240 are preserved with HCl Ail water Containers to be sampled for Lead or Metals are preserved with HNO3 All other containers are <br /> unT)reserVCd <br />