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Custody Transfer Record/Lab Work Request <br /> WESTON__Ani.__cs.Use Only '"' WE3T011 <br /> ;,: WESTON A lytics <br /> _ S 6 3 Refrigerator* 1 •1 <br /> U ,5 , I Use Onl <br /> #/T a Container -T-, Samples <br /> I :• +;; �jy-I i:�.i — a�. 1 Shipped ed _ i <br /> _j,---- _1Client �� Volume f, r ienf �--' <br /> it r -.:-: _ <br /> Vork„Order Preservative NOT "rT `a "�' 0r0e <br /> Date Due <br /> Date Rec'd. < <br /> RFW Contact ' ' ^ '�' ` - ANALYSES 2 Ambient i ed <br /> REQUESTED k. <br /> Client Contact/Phone NOTES: -7 <br /> EL,b <br /> Usey Matrix Date <br /> Client ID/Description Collected 3 Received Broken/ <br /> Leaking(Improperly <br /> `”. �'-' Sealed) <br /> Y <br /> NOTES: <br /> , 4 P perly Preserved <br /> N <br /> Y <br /> ES: <br /> OG roc. �r r- X 5 Received Within <br /> irig Times <br /> N <br /> X X ES: <br /> COC Tape Was: <br /> 1 Present on Outer <br /> Package Y N <br /> 2 Unbroken on Outer <br /> Package Y N <br /> 3 Present on Sample <br /> Y N <br /> w Metrix: W-Water DS-Drum Solids X-Other Special Instructions: ;f ; ; /f ��J�?t,i ' 4 Unbroken on Sample <br /> S-Sotl 0-011 DL-Drum Liquids :L' , NOTES: Y N <br /> SE-Sediment A-Air F-Fish -- <br /> SO-Solid WI-Wipe L- EPR'CLP Leachate n '• ;, = r�i, �< — <br /> COC Record Was: <br /> Item/Reason Relin uished by Received b . Date Time Item/Reason Relinquished b Received b Date Time 1 Present Upo eceipt <br /> of Sample) N <br /> Discrepancies Between <br /> Sample Labels and IC <br /> Record? Y N <br /> NOTES: <br /> 7-115 <br /> RFW 21-21-001/A-12/88 <br /> - <br />