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SMITH ENVIRONMENTAL TECHNOLOGIES CORPORATION CHAIN -OF -CUSTODY RECORD (See Reverse for Instructions) r <br />ROJECT NAME10 �� <br />SAMPLERS <br />PRINT)/." <br />I <br />Yetis K <br />SAMPLE CONTAINER <br />Send Lab Results to (Name): . <br />SAMPLE DESCRIPTION CODES <br />TAT CODES <br />, ' -1711 <br />SERIAL NO. X MOUNTAIN VIEW • 441 NORTH WHISMAN ROAD, BLD. 23 • MTN VIEW, CA 94043 • TEL (415) 960-1640 • FAX (415) 960-0739 <br />�/F - <br />DESCRIPTION CODES <br />SUITE 100 • PLEASANTON, CA 94588 • TEL (510) 463-9117 • FAX (510) 463-2981 <br />A. Ground Water F oil <br />B. Surface Water G. Waste <br />t. Standard <br />ROJECT NUMBER <br />J <br />// <br />r—�--=� <br />(SIGN) <br />A. 40-m1 VOA Vial <br />B. Glass Liter 0 Brass Tube <br />C. Leachate H. Blank/Spike <br />Rinseate 1. Other <br />�48 Hour <br />3 24 Hour <br />RECORDER — <br />_ <br />C. PIas1Ic 500-m1 F. Other <br />D. Plasllc Liter <br />�� <br />UE Soil/Sediment <br />4. Other <br />7 - SIGN) <br />d <br />o <br />v <br />NUMBER OF <br />ANALYSIS <br />REQUESTED <br />m <br />4 <br />LABORATORY <br />USE ONLY <br />FJ <br />�- <br />LAB PROJECT NO. <br />ANALYTICAL LAB �� / CI �t <br />c <br />uu <br />v <br />CONTAINERS <br />AND <br />PRESERVATION <br />C d <br />'v ry U <br />d <br />C <br />V <br />Q <br />x -Cr <br />D <br />C <br />'c <br />�' <br />Z <br />z <br />U <br />v <br />e <br />r <br />i <br />�: <br />W <br />3 <br />E1= o o <br />N <br />" <br />d <br />x <br />ASSIGNED <br />SAMPLE <br />AVERAGE <br />V <br />o <br />x <br />x <br />d <br />�1 <br />m <br />d v< <br />i f a <br />o <br />> <br />NOTES <br />BOTTLE <br />CONDITION <br />CL <br />b <br />„ <br />E <br />' <br />d <br />E <br />rn <br />z <br />NUMBERS <br />UPON <br />RECEIPT <br />TEMP <br />COND <br />pH <br />NO. <br />DATE <br />TIME <br />SAMPLE ID <br />°F <br />micromhosrcm------ <br />To <br />ll <br />5/,2---- <br />2 <br />3 <br />— <br />a <br />- <br />-� <br />1/ � <br />— <br />— <br />— <br />— <br />-- <br />----- <br />6 <br />aap <br />— <br />--- <br />—"- ---- <br />— <br />— <br />— <br />— <br />— <br />- <br />— <br />10 <br />111901t: <br />12 <br />— <br />13 <br />— <br />— <br />14 <br />15 <br />— <br />16 <br />NOTES/ MISCELLANEOUS f <br />� 1�• <br />Field/Container Temp. � �� Reli <br />, <br />uishod /yp+y:(Si ature) <br />�•t Si <br />Received By: (Signature) <br />Date <br />Time <br />/ ,,4 <br />rU,,,�(ri;�.r 7/'/ 1>/ —�, <br />t'JI'fP <br />�9�•.2 <br />�f 7- 7-1 C ®{ y r•u �(� I ho o to -/, 04 e f 7Z v,, /tr,l Relinquished By: (Signature) <br />Received By: (Signature) <br />Date <br />Time <br />/1, f� tile <br />Relinquished By: (Signature) <br />Received By: (Signature) <br />Date <br />Time <br />Container Sealed with Custody Seal: Yes ❑ No❑ <br />Method of Shipment Description of Other ChaingtM69tody Dispatched By: (Signature) <br />Date Time <br />Received for lab By: (Signature) <br />Date <br />Time <br />Transport Container Transported with this <br />/ Chain (by Serial No.) <br />, <br />, /' % <br />, , r, «f <br />�t <br />` <br />�(a� <br />I i0U <br />11 <br />4 6-4 " U." <br />(Check Office Below) erbals Requested: <br />Yetis K <br />No ❑ <br />Send Lab Results to (Name): . <br />SERIAL NO. X MOUNTAIN VIEW • 441 NORTH WHISMAN ROAD, BLD. 23 • MTN VIEW, CA 94043 • TEL (415) 960-1640 • FAX (415) 960-0739 <br />(] PLEASANTON • 7901 STONERIDGE DRIVE, <br />SUITE 100 • PLEASANTON, CA 94588 • TEL (510) 463-9117 • FAX (510) 463-2981 <br />