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i i i ! i i �_ i i so = i ! i �! =-� ! <br /> C C��n SIDE 2 FOR <br /> ® j �— CHAIN OF CUSTODY RECORD COMPLETE <br /> 3 2 5 b 9 RVSTRUCTIONS <br /> 'p • f'�"< / �, '` S� r ! n��c`f,. ,�f ' �' G /�_ FOR LABORATORY USE ONLY Metiioda <br /> cornmon <br /> Ship To., Project Name: ,_ ..� <br /> f -I rrj 411Address: r' Project Number: cLaboratorY ProJ�t# <br /> ' Storage Refrigerator ID 41a1 <br /> Project Location: (State) 41st Short Method <br /> Storage Freezer ID 4201 <br /> 502.2 <br /> Sampler Name Signature PPE Worn in Field �/ 503E <br /> • l r e 801$242 <br /> Da tore Reca B or M thod of ea eat I D / me <br /> 802 <br /> R f Shed$�+ f r f.r �y, r'��i' �/r INK <br /> [i0 id f 808 <br /> Relinquished By Daleli3me Re v y or Method of 5h>ptt� ent LD Date(I" a 6sic <br /> 24 <br /> 105 <br /> Relinquished By Date rime Recavod By or od of Shtpment/Shipment I D Da 11 1+ tme 0010o <br /> 8015 <br /> 0015 Mod <br /> ANALYSES REQUESTED W2° <br /> S (checko e)Level of QC ® I ❑ 2 ❑ 3 ❑ 4 Hato <br /> Write in WIND <br /> (see Side 2) <br /> ❑ 5 ❑ 6 ❑ 7 Analysis Methods 0100 <br /> Laboratory Standard <br /> x270 <br /> E <br /> pt},� SAMPLE INFORMATION `r a.,h,r <br /> FOR LABORATORY USE ONLY Description Container(s) � Chloride Side 2) <br /> Sample ID Matrix Pres COD j <br /> IAb ID Number Date Time Locator Depth # Type Type Type TAT Cow <br /> conducody <br /> Cyanide <br /> 1� L7 �' )�� ` /r 6� f4/^ ��( Ftaehpont ' <br /> Fluoride <br /> 2 X General Mineral <br /> bon Ba� um <br /> 3 lar_ / ry <� U C/ Metals(aft spealb <br /> c 7 G'A{ . metal a med sl' <br /> Matak eottr <br /> 5 / / Lr G� ' S( MetakPP• <br /> f r <br /> Metals Two 22: <br /> 6 i TnC t.errl <br /> STLC Levi <br /> 7 1",r/ , 1O 'G (ee,Sods 2) <br /> Nlrab <br /> � <br /> L <br /> I X Nitrite <br /> 8 / /!i l <br /> Org.Lead <br /> �_ �� J oft; Mercury <br /> i g l t- / I / ��'/ Peroent Moisture <br /> i <br /> / Paroard Solid <br /> 10 I / i7 ' Perchlorate <br /> PH <br /> Special Instructions/Comments Container Types A=1 Liter Amber TAT(Analytical Turn Around Tune) PhosphPhosphorus <br /> B=Brass Tube C--Cassette 1=24 hours 2=48 hours Sullats <br /> Glass Jar P=Polyethylene 3=1 week 4=2 weeks Sullidee <br /> O---Other V=Voa Via] 0=0 TC von <br /> SemNoa <br /> eta <br /> FOR LABORATORY USE ONLY Sample Condition Upon Receipt t SEND DOCUMENTATION AND RESULTS TO(Check one) Pest lade <br /> 7 , f �� [ Project Manager/Office / f'�'2' �` d�Hardne.a <br /> TOW SOWS <br /> ❑ Client Name TPt W <br /> Company — ,/�-� [��Gr Crl� TSS <br /> Turbidity <br /> Address ` • Spo*Torr or Dissolved <br /> Phone FAX <br />