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<br /> pis chain of Custc�a ��0� a Laboratory pivisiorl
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<br /> s-�oe� J�is r' Collector
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<br /> fill Sl "tm uv,�,"c�
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<br /> Affiliation-_ el�- ,tlt I-er".e' The.
<br /> ,ddress —��
<br /> AddressC3750 1111.16-1- bl,'A Sw �l
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<br /> Report to
<br /> Sample Information(1)
<br /> Date Time Type Depth Remarks(Suspected Contarninants,Con-
<br /> Lab No. Field No. (2) lainers, Preservatives,Field Conditions,etc.)
<br /> ` (Lab Use On!Yi
<br /> � / noU Wo %er5° � kG
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<br /> 10/31 lb7,o '` 13 Tahk #2 (GGoo �1)� C-e,,4 C.-
<br /> Chain of Possession
<br /> Relinquished by Date Time Received by(3)
<br /> Date Time
<br /> (Signature and aailialion)
<br /> (Signature and affiliation) r
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<br /> Logged id's at K!JIC by
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<br /> (1)A separate Latlota7nry Ana', -it.Plaques!Form is 10 be Idled out Lr the collector and given 10 the labaralory when s3mple5 are de rvered.
<br /> walei,sludge.l.oil,Or
<br /> (3)if any samples are not imici at lime aI transler,please describe on the back of this form.
<br /> Eachw
<br /> batch of 1D or fewer sample,of pacts mavix IYPe(sod.water,elc_1 unto include enough of one rnple las L•rp11;,1te analy�rs
<br /> "known In the Slalf•do cause ctrtcef 0,reP'nducUve IdnniY.
<br /> _ WARNING These sampler.contain unknown chern`calr'which,upon analysis,may be tlelermindd to r -
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