Laserfiche WebLink
Sample Chain-of-Custody/Analysis Request <br />Kennedy/Jenks Consultants <br />Possible Hsl MAR <br />t) <br />r,�•,AyxZ�r{ <br />Lab <br />DestinationClient <br />Address <br />Telephone— <br />CarriorMay Bill No. <br />Reportto--- <br />Site--- Company <br />Sampler <br />Telephone Fax <br />•'31 �0—. �RI_i ' '' `:L'wkia <br />^- <br />� L:;n e� . ' A <br />III <br />INN0 <br />�■ <br />NoME <br />�� <br />r���.���. <br />©�■■ <br />ME�MNEM <br />IMM■t <br />N�� <br />■■�■■.1■ <br />■■.M■ <br />ME MOMMEMEN� <br />on■■�■ <br />ME <br />(1) Write only one sample number in each space. (4) Preservation of sample. <br />(2) Specify type of sar le(s): Water (W), Solid (S), or Indicate type. (5) Write each analysis requested across top. Place an'r In appropriate column to <br />(3) Mark each sample which should be composited in Laboratory as follows: Place an 'X In box for each sample that should be ca posifed into one sample; use sequential letter for additional groups. Indicate type of analysis needed for each sample. <br />Kennedy/Jenks Consultants, Inc. ® 2001 <br />8 <br />