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i <br /> WE570N Analytics Use Only Custody Transfer Record/Lab Work Request <br /> 1 WESTON Analytics <br /> RelrigeratorN _ Use Only <br /> lrrrype Container Samples Were: <br /> Client _ Volume 1 Shipped or Hand- <br /> Work '-Z - r OerveredOrder <br /> NOTES: <br /> Preservative <br /> Date Recd. ''�" ' Date Due ` <br /> RFW Contact . ,� s1 1 C7,', r%.r. ANALYSES �.I r r• �� <br /> REQUESTED .r 2 Ambient or Chilled <br /> Client ContactlPhone NOTES: <br /> WA Use Only Client lWDesr-OpIllon Matrix Date � <br /> Lab ID Collected 3 Received gd Broken! <br /> _ Leaking(Improperly <br /> r: Sealed) <br /> Y i N_. <br /> NOTES: <br /> i <br /> Properly Preserved <br /> r, a r� P I, t ' .! :�' NOTES: N <br /> r 1f 5 Roceivnd Within <br /> -Hoiding Times <br /> ©�• -— __ -- — -- — _ — - - -- NOTES: N <br /> . V 1 <br /> i r <br /> cos Tape was: <br /> 1 Present on Outer_ <br /> Package YL" _.�W <br /> i �� 2 Unbroken on ureter <br /> �- Package Y N <br /> - . - --.--- 3 Present on Samoa <br /> tllatrir W•Wat.r DS-Drum Solids Special Instructions: 4 Unbroken on Sample <br /> S-Soil O-OII DL-Drum Liquids NOTES: Y N <br /> SE-Sedtmenl A-Alr F-Fish <br /> r� so�-solid VYI-Wipo X-Other <br /> J arJ IterWReason Relinquished h h Data Time Rell ulshed b Received 6 ata Time <br /> COC Record Was: <br /> 1 Present <br /> ';-F �, .: ,::i q;) r: n w i7 ') of Samples Y- N <br /> Discrepancies Between <br /> i Sample Labeis and COC <br /> Record? Y <br /> NOTES: <br /> i -- <br /> f 7-115 i <br /> FlFW 21-21-D011A 7188 <br /> 1 <br /> 3 I <br />