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1 , <br /> J t is <br /> SMITH ENVIRONMENTAL TECHNOLOGIES CORPORATION CHAIN-OF-CUSTODY RECORD (See Reverse for Instructions) <br /> PROJECT NAME _Q iJ I K �9-" (3Z SAMPLERS � � � <br /> (PRINT) SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> PROJECT NUMBER �' 2�3 -~ DESCRIPTION CODES A Groundwater F oil <br /> A 40 ml VOA Vial B Surlace water G Waste 1 Slandard <br /> (SIGN) B Glass liter E Brass Tuba C Leachale H Blank/Spike 2 48 Hour y s <br /> RECO DER C Plastic 500 ml F other O Rinseate I other 3 24 Hour <br /> {SI } D Plastic Liter E SoiVSediment 4 Other <br /> d NUMBER OF ANALYSIS REQUESTED Y y LABORATORY USE ONLY <br /> CONTAINERS <br /> ANALYTICAL LAB d AND <br /> ob <br /> e m PRESERVATION o U LAB PROJECT NO <br /> V! u a c J SAMPLE <br /> AVERAGE 3 0 x = ti Cr m a ASSIGNED y, <br /> a ¢ : a o CONDITION <br /> a s k �1 w E > NOTES BOTTLE <br /> TEMP COND pH m E m r ,� z NUMBERS UPON <br /> NO DATE TIME SAMPLE ID "F mrromhostem M LL RECEIPT <br /> 1 1AA I G10.� <br /> 2 t6.00 <br /> r i <br /> 4 1 1.1 ata µ — <br /> 5 I? 3 til LtJ- <br /> s I�t 55 V) 1'7 AW 6x <br /> 7 _ <br /> s _ t <br /> 9 i <br /> 10 <br /> 11 1 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> 16 ; <br /> NOTES/MISCELLANEOUS Field/Container TernO47 in shed By (9tgn t re Received By (Signature) Date Time <br /> r <br /> linqu shed (Signature) Received By (Signature) Date Time <br /> ,k Relinquished By (Signature) Received By (Signature) Date Time <br /> Container Sealed with Custody Seal Yes ❑ No❑ <br /> Method of Shipment Description of Other Chains-of Custody 01spa c,ed By (Slgn tura) Date Time Recetved forlab By (Signature) Date Time <br /> l� T ansport Container Transported with this , {� ,F / <br /> CQ� Chain(by Serial No) <br /> Send Lab Results to (Name) 4 �� t A �� (Check Office Below) Verbals Requested Yes ❑ No\] <br /> SERIAL NO MOUNTAIN VIEW •441 NORTH WHISMAN ROAD, SLID 23 -OTN VIEW, CA 94043 •TEL(415) 960-1640 • FAX (415) 960-0739 1 <br /> ❑ PLEASANTON • 7901 STONERIDGE DRIVE, SUITE 100• PLEASANTON, CA 94588•TEL(510) 463-9117 • FAX (510) 463-2981 <br /> 2075-" ❑ OTHER TEL FAX <br /> WHITE Fluid Copy !V[I O al Cary PINK I uqurulniy Cnpy r — (ALV <br />