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W>=STON Analytics Use Only Custody Transfer Record/Lab Work Request <br /> yy <br /> �....4a...o <br /> Refri erator# WESTON Analytics <br /> Use Only <br /> �-- #lTa Container G Samples Were: <br /> Client2� i _ Volume uJ 1 Shipped or Hand- <br /> Work Order , Preservative �/(� Delivered <br /> I <br /> Date Recd. Data Due NOTES; <br /> RFW Contest ANALYSES1G,D'L 2 Ambient or Chilled <br /> ! Client Contact/Phone REQUESTED ON-3675 t� ( NOTES: <br /> k A Use Only Client ID/Description Matrix Date <br /> # Lab ID Collected 3 Reoelved Broken/ <br /> Leaking (Improperly <br /> �� Sealed) <br /> i Y N <br /> 2 V(/ I ✓ NOTES: <br /> VV 3 v 4 Properly Preserved <br /> Y N <br /> NOTES: <br /> 5 Received Within <br /> i Holding Times <br /> l <br /> NOTES: <br /> COC Tape Was: <br /> 1 Present on Outer <br /> iPackage Y N <br /> 2 Unbroken on Outer <br /> Package Y N <br /> i 3 Present on Sample <br /> Y N <br /> I Matrix: W-Water DS-Drum Solids X-Other Special Instructions: 4 Unbroken on Sample <br /> S-Soll 0-011 DL-Drum Liquids NOTES: Y N <br /> SE-Sedlment A-Air F-Fish <br /> i SO-Solid WI-Wlpo L- EPrrCLP Leachato <br /> Item Reason lin uis b Received b Date Time Item/Reason Relinquished b Received b trate Time COC Record Was: <br /> _ i Present Upon Receipt <br /> of Samples Y N <br /> Discrepancies Between <br /> Sample Labels and COC <br /> Record? Y N <br /> NOTES: <br /> T-t15 <br /> RFW 21-21-001/A-12/88 <br />