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Kennedy/Jenks/Chl)ton, Laboratory 01YISlon <br /> Field Samole Chain or Custody_ Record <br /> Sours_ of Samole s l'/9/ - �' �j� �l� /��G Collector z�L/ <br /> ( ) - - - l �_ / <br /> Address l� _!+ Cr�hs�!iI' 7' Affiliation '��t//��. �C � lC; <br /> Address�il �a <br /> { Phone <br /> Rcoort to ( L) f_^� _/�`� � (� Phone <br /> T <br /> Samicl a 1n1:orma.ion K/J/C Joo I`iumoe� � <br /> i Tyoe <br /> L_o No . Field No l7a_e Tine ( 2) Oeoth Rlamar`cs (Susoectad Can:aminants , <br /> Fiala Conditions , etc ) <br /> � I I <br /> Chain 4i Posses-; ,On <br /> Relinqulsrea 7v Oat= Time Received by (3) Oaz=_ Time <br /> (Sionatare inc aiiillation) (Stanacura ana arrlh aZionj <br /> ` fel <br /> LoaQEd 1n at K/J/C by / 1 <br /> (I) A separata RaqueS, For analysis form 15 to be filled out by the collector ana Given to <br /> the Laooratary wnen samoles are deliverad. (2) e .g. water , sludge, soil , ecc_ (3) If any <br /> samolas are not iniac, al: time of transfar, please describe on the bas's or this form. <br /> cac'l oaz:i of 10 or -abler samplas of each matri ( tyoe (5.711 , wate-, a--: ) must include enoucn <br /> of one sample for triolicata analysis. <br /> 'dARM NG These _amo 1 as contain unknown chemicals 'rh i cel , Iloan analysis , may be ae:-2—n1 neo _O <br /> be ",io'vn to�tne `t_ta to cause cancan or raornauczive Co (1c1Lv° , unde- Vie tai -or-lia Sa-a <br /> �rii\iilU �>Ii"='' _�L Ipii�_ ;1i�f_�"'Qr1L yCt X77 L`3P�3 (�F'�G175i=1Qn owl <br /> (r ;^C <br />