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"!JrChain rr�uaufer <br /> Custody Record <br /> � � r <br /> CWA4124 S <br /> Client Project Manager �.� j n Data Chain Of Custody Number <br /> Address r Telep ne Nu ber(Area Code)lFax Nthbet Lab tuber I / <br /> t L.S �' C Page of�L� <br /> Crry State Zip Code site Miitact � Analysts <br /> Project Name E Cemer/Waybrtl Number <br /> AP <br /> Contract/Purchase Order/Ouote No <br /> Total Containers Preservative Condrbon on Recet <br /> Sample!D No and Descnptton Date Time Sample Type Volume Type No pt <br /> /G C <br /> AIL <br /> S <br /> Special Instructions <br /> Possible Hazard Idenhfication Sample Disposal <br /> Non Hazard ❑Flammable ❑Ski,lmtant ❑Poison B ❑Unknown Return To Clrertf ❑Disposal By Lab ❑Archive Far Months <br /> and Time Required OC Levet Project Specific(Specify) <br /> al ❑Rush ❑i DuElm _ <br /> 1 Relinquished By IF Time / I Received By <br /> � t Date Time / <br /> 2 Relinquished By Date rrmd 2 RecervOd Oy 1 ° Data Time <br /> � r <br /> t ! <br /> 3 Relinquished By Date Time 3 Received By Date Time <br /> Comments <br /> DISTRIBUTION WHITE Stays with Sample CANARY-Returned to Client with Report PINK Field Copy <br />