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WESTON Analytics Use Only <br /> It f�rFf�;�,,;a ► Custody Transfer Record/Lab Work Request WW' U.-. ,,. <br /> Page <br /> • Client S Refrigerator 0 • <br /> Est.Final Prol.Sampling Date #Rype Container Liquid r; 1;4-4 <br /> Work Order N SglidLi uid <br /> Project Contact/Phone volume <br /> #f 3 - <br /> Solid <br /> AD Praject Manager Preservallves <br /> OC Del TAT ORGANIC IN RG <br /> ANALYSES <br /> Date Recd '7 hi l s-. Date Due REQUESTED ---Amp– a a �� -e I �� (q <br /> Accounts O� m a a_ i 4 D 4 H .t4 <br /> (MATRIX <br /> CODES: Matrix <br /> S- Soil fD Client ID1DBscHpllon OC Matrix ll <br /> Collected <br /> SE-Sediment Chosen <br /> SO-Solid (✓} <br /> O- Oil de a <br /> 1 7-10t <br /> f� <br /> A- Air <br /> DS-Drum v 4 <br /> Solids <br /> DL-DrumrJv� <br /> Liquids <br /> L- EPITCLP . # <br /> Leachate 5 <br /> WI- Wipe <br /> X- Other Pi5 <br /> IMM, 6B <br /> F- Fish <br /> 1161$ Apg l <br /> Special Instructions: DATE/REVISIONS: <br /> WESTON Analytics Use Only <br /> M JJ 1. <br /> I t IQr�r- 31/D N,%�eS 2 Samples were: COC Tape was: <br /> L 1)Shipped_or Z 1)Present on Outer <br /> 1 Hand irbill Delivered Package Y or N <br /> 4. 2)Unbroken on Outer <br /> 2,_R0JG..F'3) <br /> hillePackage Y or N <br /> 5. <br /> _ 3} a ePresent on Sample <br /> 6- Condition(Zor N Y or N <br /> Relinquished Received Relinquished Received Discrepancies Between 4)Properly Preserved 4)Unbroken an <br /> Date Time Date Time Q or N Sample Y or N <br /> b1i by by' Samples Labels and <br /> ` COC Record? Y of 5)Received Within COG Record Present <br /> NOTES: Holding TI s Upon Same Reo't <br /> or N [yjor N <br /> RFW 21-21-001/A-8/90 L372 L373 L375 L377 L378 Ref# Cooler# 381-596a <br />