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Noun <br /> WESTON Analytics Use Only Custody Transfer Record/Lab Work Request �] <br /> 921 0 5 1 3 4 Refri erator# W Use Only e TONOnly Analytics <br /> #rrype Container ;� �!� %� Samples Were <br /> Client _ ' I` r Volume w, < < 1 Shipped or Hand- <br /> work Order ' ,t ' t Delivered <br /> Preservative l I �„ <br /> Date Recd Date Due NOTES <br /> RFW Contact i �' — ANALYSES <br /> r, " t _ ,, i REQUESTED z Ambient or,Chrlled <br /> Client Contact/Phone�. ,_ r_r NOTES <br /> A Use OnlyDate �� <br /> Lab ID Client IDIDescnption Matrix Collected 3 Rece4ved Broken <br /> Leaking (Improperly <br /> Sealed) <br /> NOTES <br /> 4 Properly Preserved <br /> lJY1 N <br /> OTES <br /> 5 Received Within <br /> Holding Times <br /> tY) N <br /> NOTES <br /> COC Tape Was <br /> 1 Present on Outer <br /> Package Y iN <br /> 2 Unbroken on Outer <br /> Package Y N <br /> 3 Present on Sample <br /> Y ,N <br /> Matrix W-Water Ds-Drum Solids x-Other Special Instructions ' r'a j 4 Unbroken on Sample <br /> S-Soil 0-011 DL-Drum Liquids NOTES Y N <br /> SE-Sediment A-Air F-Fish <br /> SO-Solid WI-Wipe L- EPlrCLP Leachate <br /> COC Record Was <br /> Item/Reason Relinquished by Received by/ Date Time ItemlReason Relinquished by Received by Date Time 1 Present Upon Receipt <br /> aof Samples`Y N <br /> 01 Discrepancies Between <br /> Sample Labels and COC <br /> Record? Y �l,4 <br /> NOTES <br /> 7-11S <br /> RFW 21-21-0011A-12188 <br />