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W --vPROJECT NA0,1 #t SAMALERS tX (PRINT) , SAMPLE CONTAINER , SAMPLE DESCRIPTION COD _ TAT CODES <br /> t r ' A G(aundWaler F oil <br /> 1 PROJECT NUMBER <br /> DESCRIPTION CODES' <br /> A 40 m1 VOA Vial ' B Surface,Water O Wasle 1 48 Hour 6 ( GN) C Leachate H Blanklspike 2 4B Hour <br /> l B Glass Lller E Brass Tutie <br /> yam,i 1 vt' n ' n y�� C Plastic 500 ml F Olhar D Fllnseata I Other 3 24 Hour <br /> RECORDER E 5aIV5edimenl 4 Otner <br /> (SIGN) D Plastlo Lilar_ t <br /> ' 1 mNUMBER OF ANALYSIS REQUESTED yr LABORATORY USE ONLY <br /> u u CONTAINERS m <br /> s <br /> ANALYTICAL LAB <br /> AND o V L.AB PROJECT NO <br /> go <br /> c <br /> PRESERVATION � � tl`� � f! <br /> ' m <br /> v Y Q � <br /> 0356 d E <br /> 1 u m c J n m Ei-$ SAMPLE <br /> AVERAGE 0 o T s v m o a ASSIGNED CONDITION <br /> m o � � �- r � � F °> NOTES BOTTLE UPON <br /> TEMP COND pN <br /> W E d h ►a- Z NUMBERS RECEIPT <br /> +, NO DATE TIME SAMPLE ID 'F micromhoskm "' N tL <br /> X <br /> I tr 130 <br /> 4 Z 41 4, <br /> O D . 3 A A X taaG <br /> v J• -4- a X ! l <br /> t �1„ <br /> t12 <br /> , z <br /> pit '+13 r' ' <br /> 1 �F <br /> N „ <br /> A } <br /> 1 <br /> eJ4�tt 1 1 <br /> NOTESlMISCELLANEOUS ; FIeIdlContalnerTemp �— Rei quishedBy ( Ign re) I , Received By (Signature) Date Time <br /> , <br /> r <br /> Re inqulsh By (Signature) Date Time <br /> ecolved By (Signature) <br /> I;i r '•' _ {' Rsllnquished By (Signature) deceived By (Signature) Date Time <br /> i'." Coptalner Sealed with Custody Seal Yes ❑'•,No❑ r' r , 6 <br /> � t <br /> rw�k a11;�Aethod of Shipment Description of , 'Other Chains-of-Custody Dls tched By {Si ature) Date Time-, Received for lab By, (Signature) Date Time <br /> TransportContalner r` n 'T'ransportedwith this <br /> �y� �' ,'— <br /> ! CD 1} { 1 C Chain(by Serial No <br /> - t <br /> Send Lab Results to (Name)' 2l r" �� ~C5Ag- _ (Check offlCeQelow), Verbals Requested. Yes El No 1 <br /> SERIAL NO MOUNTAIN VIEW a 441 NORTH WHISMAN ROAD, BLD 23•MTN VIEW, CA 94043 a TEL(415) 960-,1640 e FAX(415),960-0739 <br /> 1t `t ❑ PLEASANTON •,7901 STONERIDGE DRIVE, SUITE 100• PLEASANTON, CA 94588 e TEL(510) 463-9117• F�X (510) 463-2981 <br /> C{ <br /> �0 V 47 ❑ I . 1Y ' `FAA ' <br /> OTHER TEL <br /> t;' WHITE Fl�ld Copy Yj 11 OW Prnlacl Copy � PINK l eitonlory Cody HEV 0l05 <br /> �, I <br />