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I <br /> �Ro ® McClelland <br /> FO- Vta(7193) <br /> CHAIN OF CUSTODY RECORD <br /> LABORATORYLABORATO�LDiC Dk DATE12 <br /> f FM JOB No —� <br /> CLIENT PROJECT <br /> PROJECT MANAGER Ll.�. SAMPLER(Signature) <br /> Ln f� <br /> F <br /> xborar orV Sample Location artd Dasoriptlon date s Vessel No at triSemple Fressrvation Tests Hrtluked <br /> No. No Type Veasels Max Method oft <br /> - <br /> no <br /> W lVO4 3 142_,, 14(,L <br /> VESSEL TYPE SAMPLE MATRIX p FEST REQUIRED <br /> 1 Bran or stainless steel sleeve 2%-inch diameter by 1 3 4 or B inches long A Air A r 4,. <br /> 2 Bross or stainless steel sleeve 1% inch diameter by 4 inches long S Solid B �- <br /> 3 Stainless steel sleeve 1 inch diameter by 8 inches loop Water C <br /> 4 Amber glass borde with Teflon lined screw cap 1 000 millrters O Other D <br /> 6 Amber gloss bottle wth Teflon fined screw cap 260 milUUre PRESERVATION METHOD E <br /> !) Clear plus pr with Teflon lined screw cap 4 or 6 ouness A Artificial nee F <br /> 7 VOA vial 40 mdBbters 8 NaHSO. G <br /> 8 Mason ler 1 pint or t quart C HNO, H <br /> 8 Plastic bottle 1 liter D Nona E <br /> 10 Other Other ( L J <br /> RELINQUISHED BY (Sgnsturel RECEIVED BY ISwnaturel DATE. TIME <br /> RELINQUISHED BY lS,pnature) RECEIVED BY ISpnaturel DATE TIME <br /> RELINQUISHED BY (Signature) AEC VIED FCkR tABORA ORY B (Sipnetwe) DATE. TIME <br /> I Ila 6 (4 C_ <br /> METHOD OF SHIPMENT TURNAROUND TIME SAMPLE DISPOSAL. <br /> 5�4C,,,� ❑ Return to FM -91 Proper disposal by Lab after eO days <br /> SPECIAL INSTRUCTIONS <br /> HANDLING INFORMATION <br /> Wtate FM Copy Yellow - Leborstory Copy Pink - Retum to FM with Results <br /> 5855 011vas Park Drive a Ventura, Cal forma 93003-7672 (SOS) 650-7000, F 7010 <br />