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0 • • . <br /> CHAIN OF CUSTODY 1P 0 .5 � � L <br /> SAMPLER TOSCO ,.77r ANALYSES REQUESTED <br /> S <br /> SIS # SS b'6 CITY c *A N TURN AROUND TIME <br /> WITNESSING AGENCY ADDRESS � d J CII /UI QYGL C <br /> Q � y <br /> SAMPLING `+� REMARKS <br /> SAMPLE ID NO DATE TIME WATER GRAB COMP NO OF CONT LOCATION �Q <br /> S �1��9� �� 3I v �¢� tJQ.LP X ?� JC 7050707 <br /> 3 4) <br /> d c <br /> G <br /> bo � <br /> RELINQUISHED BY DATE/TIME RECEIVED BY DATE/TIME THE FOLLOWING MUST BE COMPLETED BY THE LABORATORY ACCEPTING SAMPLES FOR ANALYSES <br /> 4 1 HAVE ALL SAMPLES RECEIVED FOR ANALYSIS BEEN STORED ON ICE? T t7f <br /> {SIGNATURE) S S�� (SIGNATURE} 1 2 WILL SAMPLES REMAIN REFRIGERATED UNTIL ANALYZED? <br /> {SIGNA �� <br /> URE) �� I R '� 3 DID ANY SAMPLES RECEIVED FOR ANALYSIS HAVE HEAD SPACE? <br /> (SIGNATURE) ( IGN ) 4 WERE SAMPLES IN APPROPRIATE CONTAINERS AND PROPERLY PACKAGED? ' <br /> (SIGNATURE) (SIGNATURE) SIGNATURE TITLE DATE <br /> Note All water containers to be sampled for TPHG/BTEX, 8010 & 8240 are preserved with HCL Ail water containers to be sampled for Lead or Metals are preserved with HNO3 All other containers are <br /> unpreserved <br />