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e <br /> f„ r <br /> SMI NVIRONMENTAL TECHNOLOGIES CORPOICON CHAIN-OF-CUSTODY RECORD (SeeReve rinstruetions) ' ,a <br /> PROJECTNAME 01V�4�T2 ' rL SAMPLERS `:' L SA A �a e e <br /> •} Q ,w ;� ' aur ,, (PR t +1 1 'r ' SAMPLE CONTAAEA� SAMPLE DESCRIPTION CODES TAT CODES " <br /> l 1 �,�Q i' �� DESCRIPTIONICbDE� A tlro�ndWarer Foil <br /> PROJECT NUMBER- + si�T °� t3 Su ace water a W. la 1 Standard <br /> +' r' + I A ao ml VOA Mat -.d 3t '� n S� <br /> 1 �3 .! j, $ ,� ♦ , x r 1 s ;sipNl,- , n ry I13 ` R� G <br /> n + B plee�Llfar Ir Bnn""Tu' <br /> C Leachate H 131a k/ 2 49 Hour ! <br /> s <br /> e ,! r'I r D Rlneeale I Olher 3 74 Hour <br /> RECORDER � ' � } . � C Plasllo 5l)0 ml FI'll � r�lher I <br /> Vj p 5)+ (SIpN);,r �`� ;! t, r I ,It y] ,i � i ' D Plas110 Lltarr„ ,C�a E SoIVSedlmenl 4 Olhar , <br /> �r <br /> NUUBER OF ANALYSIS REQUESTED ;ar ` g LABORATORY USE ONLY ' <br /> CONTAINERS ? m <br /> ANALYTICAL. LAB s�y � O � ' ` � <br /> 5 PRESERVATION { '@ , 6 y � � LAB PROJECT N <br /> c v <br /> - ..} .@.+ � 4 � �� @ (rte •� <br /> �5i¢ ria <br /> o J 9 ,, rEt= ° i SAMPLE <br /> AVERAGE x r d Cr f,< m a ASSIGNED <br /> m a ° C o CONDITION <br /> N A 9@ c 4 �. d - x a } NOTES BOTTLE <br /> TEMP COND pH E m ' z NUMBERS UPON <br /> NO DATE TIMI; SAMP E ID •F mlaaunhosrcm y s' RECEIPT <br /> 2 .0 J r._ <br /> 3 it 40 - a �( <br /> a ) o II i`,`fit <br /> 511' - s r •\ `� KC aJ <br /> $ 1 111-23 : ° V i' <br /> - a <br /> i 1.4 11 r 1 <br /> a W- <br /> 9 1 — I rG5 &182; A Wam Y, X <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 , <br /> NOTES/MISCELLANEOUS Field/ContalnerTemp Relinquished By (SI natu ) 5 Received By (Sigr)ature) Date Ti <br /> , <br /> Himinc,1111shedby (Si ature) rP' Received By (Sign atu ) Date Time <br /> ,F- <br /> secalved�By (Sign ignature)' %r j iDate Time <br /> Container Sealed with Custody Seal Yes NoF-11;n- <br /> —?-p <br /> Method of Shipment Description of ' Other Chains-of-Custody sp t had By igna�re� �'] Date Time:', 'Rbdeiveti for lab By (Signature) Date Time Asn <br /> Transport Container s Transported with this <br /> Chaln(by Serial No) lo <br /> l YJ "• �r ��! r , " �i / rY <br /> Send Lab Results to (Name) `Y � G � AR- �`-� _ (Check O'flice6eloV';} Verba7s Requested Yes ❑ No` <br /> tRiAL NO MOUNTAIN VIEW-441'NORTH WHISMAN ROAD, BLD 23 • MTN VIEW, CA 94043-TEL(415)'96 -i 0 SAX (415) 960-0739 <br /> r� <br /> n ❑ PLEASANTON -7901 STONERIDGE DRIVE, SUITE 100• PLEASANTON, CA 94588•TEL(510)463-9117 FAX (510) 463-2981 <br /> 7 L] OTHER ` TEL FAX <br /> ' <br /> WHITE Field Copy YELLOW Proleol Copy PINK Laboratory Copy ! Rta♦11410If r,<< <br />