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! 0 � �, <br /> CHAIN OF CUSTODY Q <br /> SAMPLER TOSCO <br /> ANALYSES REQUESTED <br /> t VAR TKES T/�st/T l�l1L� S/S # 5?.FE CITY -7 DC 4 TURN AROUND TIME <br /> f // 4q <br /> WITNESSING AGENCY ADDRESS Z �I 1,I/. MQYc,L fl'L• �} 7C Q <br /> SAMPLING �+ `�1 REMARKS <br /> SAMPLE ID NO DATE TIME WATER GRAB COMP NO OF CONT LOCATION <br /> 141 �; 3 vb,4ot# X X 705 19'7 <br /> M IL A ' X x -� t � X X 05 198 � � <br /> f13 ' ` X x <br /> 17050199 <br /> Lk A y /. x V -� X x x 70-5020* <br /> ;A W �S Z X X X X 705ftp1 <br /> 04w s--b 1zM X X X X X 705 202 <br /> �W 5lS r X X � Y X X X 05 203 � <br /> M�1 Co 3� 1 X x 4 �- X ?� 705; 204 � �► <br /> M w G S <br /> 3: ) <br /> ly S X K X 170.502,P05 , <br /> 11,-r,� <br /> �?W fl� X x X K 1705+206, <br /> RELINQUISHED BY DATEITIME RECEIVED BY DATE/TIME THE FOLLOWING MUST BE COMPLETED BY THE LABORATORY ACCEPTING SAMPLES FOR ANALYSES <br /> :;13 5,) D I HAVE ALL SAMPLES RECEIVED FOR ANALYSIS BEEN STORED ON ICE? k GS <br /> � ZS <br /> {SIGNATOR ) (SIGNATURE) 2 WILL SAMPLES REMAIN REFRIGERATED UNTIL ANALYZED? <br /> 3 DID ANY SAMPLES RECEIVED FOR ANALYSIS HAVE HEAD SPACE? Nv <br /> (SIGNATURE) ?7 Ta J <br /> f <br /> (SIGNATURE) <br /> IG ATURE) v 4 WERE SAMPLES IN APPROPRIATE CONTAINERS AND PROPERLY PACKAGED? S <br /> (SIGNATURE) (SIGNATURE) SIGNATURE TITLE DATE <br /> -31- <br /> Note <br /> aNote All water containers to be sampled for TPHG/BTEX, 8010 & 8240 are preserved with HCL All water containers to be sampled for Lead or Metals are preserved with HNO3 All other containers are <br /> unpreserved <br />