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MANDEVILLE & ASSOCIATES CHAIN-OF-CUSTODY RECORD <br /> envirwoentel engineering services <br /> PROJECT NUMBER PROJECT NAME <br /> 7o Y 81 oro L - <br /> SAiiPLE CONTAINER PREPARATION FIELD SAHPLINS RECORD <br /> SAMPLE PREPARED BY DATE TIME ISSUED TO SAMPLER SAMPLER DATE TIME CONDITION FIELD TESTING SAMPLER <br /> CONTAINER CONTAINER NO. IN LABI P,, LOCATION <br /> FL.w O 'f y L 3/ gg 1505t x/00 �2 1 <br /> i <br /> RELINQUISHED BY: DATE TIME RECEIVED BY: RELINQUISHED BY: PATE TIME RECEIVED BY: LABORATORY <br /> ( S ATU E ) 7/ (a ( Sf NATU ( SIGNATURE ) ( SIGNATURE ) NAME <br /> G "t <br /> ELINQUISHEO BY: DATE TIME RECEIVED BY: RELINQUISHED BY: DATE TIME RECEIVED BY: <br /> ( SIGNATURE ) ( SIGNATURE ) ( SIGNATURE ) ( SIGNATURE ) <br /> RELINQUISHED BY: DATE TIME RECEIVED BY: IARPE9 MIUMI R ETRO T TA-TrM COMMENTS: — <br /> ( SIGNATURE ) ( SIGNATURE) ( SIGNATURE ) (SIGNATURE ) <br /> RELINQUISHED BY: DATE TIME RECEIVED BY: RECEIYED FOR LABORATORY BY: DATE TIME REMARKS <br /> ( SIGNATURE ) ( SIGNATURE ) ( SIGNATURE ) <br /> 0 <br /> A NOTE: EMPTY = E EMPTY-1/4 = 1 1/4-1/2 2 <br /> 1/2-3/4 = 3 3/4-FULL = 4 OVER FULL = 0 REVIEWED BY: DATE: <br />