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�ZMi <br /> rE.,DE2;'F�0R <br /> `� 46 <br /> ` R CHAIN OF CUSTODY RECORD 3 2 5 7 0 COMPLETE <br /> INSTRUCTIONS <br /> / r <br /> Ship To: r F�; ;'J�r, ' �T f r� Project Name: 4�) %t.�� f�= r`� c FOR LABORATORY USE ONLY <br /> _ ' Pro,etNumber: <br /> 4111Address: -{� Laboratoryj <br /> / Storage Refrigerator ID y ?i l , 1Z. 41&1 <br /> f r f<{- 1 r{ _ Project Location:{State) - T 416,1 Short Method <br /> Storage Freezer ID 4201 <br /> sou <br /> Sampler Name Signatgre PPE Worn m Field y 509E <br /> �' � /,f _ .f• /,moi <br /> r i / r r i 601 <br /> Reltngtnshod By a t e B f Sh ent/Shipment I D ear <br /> f ��` f 606 <br /> Relmgtnahed By F i Date[Linic Reoety� or Method Sh en hlpmerit LD D e e� <br /> Relmgliished By Dater rime Received By orMethod of Shrltirient%gxneru LD Ds une 99010 <br /> Boss <br /> 601:Mod <br /> Sample Disposal Level of ® 1 ❑ 2 ❑ 3 ❑ 4 ANALYSES REQUESTED W21 <br /> I Write to sm - <br /> (check one) am <br /> ® (see Side 2) ❑ 5 ❑ 6 ❑ 7 Analysis Method }e 910D <br /> 8240 <br /> Laboratory Standard A am <br /> Other SAMPLE INFORMATION �htty <br /> BTFX <br /> DescriptionContamer(s) �� as 9"SO*2) <br /> FOR LABORATORYIISE ONLY Sample ID Matrix Pres <br /> Idb lD Number Date Time Locator Depth # Type Type Type TAT ColorCoN <br /> ky <br /> cymwe <br /> rc Fas* r <br /> 2 I l k`, ,L,Cv tG . General Mineral <br /> Hex.Chromlurn <br /> 3 bra l#alanoe <br /> Metals(wilt.spearia <br /> 4 mew a rrWd I). <br /> Mews 9o10• <br /> metals PP' <br /> s Metab Tide 22: <br /> 6 �' TTLC Level <br /> STLC Level <br /> r (see Sde 2) <br /> i Ndrate <br /> g 1 NOrde <br /> J Org Lead <br /> 9 sF Org Mercury <br /> I Percent Monturs <br /> lb Percent Sold <br /> Perchlorate <br /> PH <br /> Special dnstructions/Comments Container Types A=1 Liter Amber TAT(Analytical Turn Around Time) Phosphates <br /> B=Brass Tube C--Cassette 1=24 hours 2=48 hours Phosphorus <br /> SuNate <br /> s ; G--Glass Jar P=Polyethylene 3=1 week 4=2 weeks Sufldes <br /> TC0--Other V=Voa Vial 6=OtherLP <br /> Samm <br /> FOR LABORATORY USE ONLY Sample Condition Upon Receipt SEND DOCUMENTATION AND RESULTS Tq(C one) a ,aad. <br /> ProjectManageI/Office � rJ / C;_ ����r�c/� f-_ �Hardnes <br /> Tod Sotds <br /> ❑ Client Name / r�f TPKD <br /> Company ���{ ` �� � S�M <br /> / <br /> f Address •spealy Total or DissoMW <br /> Phnn� CA V <br />