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INTERNAL SAMPLE TRACKING <br /> AND DISPOSAL RECORD <br /> Purveyor Lk—CL4 11 \ �j� Ch iltbCase or Project # <br /> CWL Sample # Dispose Hazardous CWL Sample # Dispose Hazardous <br /> F'- 58352 <br /> P- 58353 <br /> Relinquished by: Date/Time__�Z/ L­Received by F <br /> Relinquished by: Date/Time r Received by ✓� <br /> Date/TimeReceived by <br /> Relinquished by: Date/Time Received by <br /> Placed in truck by: Date/Time- <br /> 2Z <br /> Position in truck: Row Z Section L <br /> Removed from truck by Date/Time <br /> Placed in truck by \\ Date/Time 22 11 <br /> Disposed of by, / Date/Time Jlz <br /> Method of disposal <br /> Complete: <br /> Amber Gal <br /> Amber liter # of original containers:,-�, <br /> � gallon plastic # of splits: <br /> quart plastic Location <br /> VOA vial �J Inorgani :vZ Orgar : oC <br /> Soil tube <br /> Green top glass <br /> V Extraction oL <br /> Misc. Mass pec: Bio-Assay: <br /> Pcb's <br /> Asbestos_ <br /> Bacti <br /> Sent out <br /> Air s <br />