Laserfiche WebLink
Field Sample Chain of Cv-Iody Record Kenniedy,3anks,Chilton <br /> t, %,r 14 t %000Laboratory Division <br /> Source of Sample (s) SL) S 0 — Job No. OU $q04 2- <br /> '— Sta t. �c��f _ collector Zot""' 2%Assell <br /> Address S�tauL� Affiliation <br /> `' 3 —2 5-0 utb�r 81vd 5.�;4e <br /> Address <br /> Phone S4cr o G4 `15$z <br /> Report to <br /> Phone Ij&— OF— 7 Z Z Z <br /> �. Sample Information (1) <br /> Lab No. Field No. Date Time Type Depth Remarks (Suspected Contaminants,Con- <br /> (Lab Use Only) (2) tainers, Preservatives, Field Conditions,etc.) <br /> 03LI !Z lz v/j o m57 &t 75-44 6x(sat,r,er . I� 91,: 4-Xt <br /> 035 (� J101 it 13 �j 01eld TA-,I! 1 6r4Ss 4--k <br /> 036' t+ I10 +f ) 3 ft- 1t <br /> 037 11 I11(o ,i 2.75{ tr <br /> 0 34s tt 7127 Ik Z�f lo-, .t <br /> O 3 g tt )t 36 M 11 " <br /> �- <br /> 0K0 " 1jy3 * d3 �t " <br /> 0 q! (` /15-z 3 f+ <br /> O q Z h 1 z0 z. w 3 K <br /> 0 Lt 3 h )zo� " <br /> Chain of Possession i <br /> Relinquished by Date Time Received by(3) Date Time <br /> (Signature and affiliation) (Signature and affiliation) <br /> �. 1zfu lye 0 3o <br /> 2. <br /> #- Logged in at KIJIC by <br /> (1)A separate Laboratory Analysis Request Form is to be filled out by the collector and given to the laboratory when samples are delivered. <br /> (2)eg.water,sludge,soil,etc <br /> 6.0 (3)h any samples are not intact at time of transfer,please describe on the back o1 this form. <br /> Each batch of 10 or fewer samples of each matrix type(soil,water,etc.)must indude enough of one sample for triplicate analysis. <br /> WARNING These samples contain u,*nown chemicals which,upon analysis.may be determ;ned to be"known to the State to cause cancer or reproductive toxicity" <br /> 1.r <br />