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i <br /> SMITH TECHNOLOGY CORPORATION CHA -OF-CUSTODY RECORD (See Reverse for instructions) <br /> PROJECT NAMF r i SAMPLERS <br /> (PAINT) SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> PROSECT NUMBER Y `t (`1�, r t 1 (r if_e DESCRIPTION CODES A Ground Waler F Oil <br /> ` A 40 ml VOA Vial R Surface Water G Waste i Standard <br /> { I t ] I(SIGN) B Glass Liter E Brass Tube C Leachate H BianklSplke 2 46 Hour <br /> RECORDER ' h C Plastic 500 mk F Other D R nseate I Other 3 24 Hour <br /> 1 ,(SIGN) D Plastic Liter E SoillSediment T 4 Other _ <br /> - E <br /> NUMBER GF ANALYSIS REQUESTEDLABORATORY USE ONLY <br /> o c° CONTAINERS <br /> ` <br /> ANALYTICAL LAB {[ y t ° O E a L LAB PROJECT NO <br /> i i 1 l y U C1 <br /> PRESERVATION 71 c <br /> 0 V y <br /> a a <br /> U 12 <br /> AVERAGE °+ i i _i �-19 tr d m a ASSIGNED SAMPLE <br /> E ° NOTES BOTTLE CONDITION <br /> TEMP COND pH m E � m � -+� F N Z NUMBERS UPON <br /> NO DATE__ TIME SAMPLE ID F rrvcrurnhustm r /e r"n u t�` T---_ — RECEIPT <br /> vj�X11 - <br /> 2 �I - - - - - - - - -- - - - - - - - - - - - - - - <br /> -6 I - - I - - -- -- — — —— - - --_--{----- <br /> 9 I - - - - ---- - - -- — - -- -- - - _ -I <br /> 10 - - -- ------ - — -- ---- — I - - - -- <br /> 12 - - - - - - - - - - - - - - - - - - <br /> 141- - - --- -- __��_ -- - - - --- -- ---- - - --�--- -- _ � � - <br /> 15 � _� _ - - - --- - — - -- -- --- - - --- - - - <br /> NOTES/MISCELLANEOUS Field/ContalnerTemp Relinquished By (Signature) <br /> 4Rece4ived <br /> 2 _�ignature) <br /> Dy/at�eITime ime <br /> i \ R�(Signature) (SI ture) ) 7 Date Timequlshgecelved y (S. nature) Date Tlme By (S nature)t 1 r!( <br /> t� <br /> Relinquishe <br /> Comalnei Sealed with CuylodySeal Yes No ! 1 r}4 ',' 'j,tf i;( t�t It, L a !'IFk _ <br /> Method of Shipment Description of Other Chains-o!Custodyl Dispatched By (Signature) I,' Date Time Received lot lab BBy/(Signature) Date Time <br /> r Transport Container Transported with this <br /> , Chain(by Serial No <br /> Send Lab Results to (Name) ) ( t t ` ` ' r 1 (Check Office Below) Verbals Requested Yes C, No ❑ <br /> SERIAL NO MOUNTAIN VIEW • 441 NORTH WHISMAN ROAD, BLD 23 - MTN VIEW, CA 94043 -TEL (415) 960-1640 - FAX (415) 960 0739 <br /> PLEASANTON -7901 STONERIDGE DRIVE, SUITE 100- PLEASANTON, CA 94588 -TEL (510) 463-9117- FAX (510) 463-2981 <br /> j I OTHER TEL FAX <br /> WI IH E Fr[1d Copy YEI I OW Pru,cci Copy PINK Labor'lory Copy REV 9f95 <br />