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• SMITH ENVIRONMENTAL TECHNOLOGIES CORPORATIONCHAIN-OF-CUSTOD 1 RECORD (See Rev�rsefortn�, Y <br />J SAMPLERS 1 ` 'r <br />PROJECT NAME �,1r —� T=—L ' (PRINT) SAMPLE CONTAINER SAMPLE DESCRIPTION CODES <br />TAT CODE+ <br />7 / DESCRIPTION CODES B Groundwater G oil / � <br />___-- <br />A. 40-m1 VOA Vial C, Sumacs Water H. Waste 12. Standard' <br />PROJECT NUMBER �—__�_' __.— ` ; (SIGN) B. Glass Liter 0 Brass Tube C; Le9chate H. OtherBlankSpike 2. 24 Hour <br />`+�' Rniseate i L Other 3. 24 Hour <br />/ / � , C. Plastic 500-m1 F. Other— Soil/Sediment 4. Other <br />RECORDER _ r - D. Plastic Liter <br />(SIGN) <br />NUMBER OF ANALYSIS REQUESTED d LABORATORY USE ONLY <br />l_ o °u CONTAINERS — —" — - — — t , <br />-- AND - <br />m „ v <br />U U <br />/ Y m ,; LdEeT N07 <br />ANALYTICAL LAB `'' �i PnrsEnvnnoN 60 <br />c t.. x c <br />« a ii <br />m n> \ m EH o: o i; SAMPLE <br />a d z m `, ;, a Q ASSIGNED CONDITION <br />AVERAGE o a = _ = +�_ h. -� °° NOTES BOTTLE UPON <br />_ E; o w; s o! N i NUMBERS RECEIPT <br />TEMP COND pH A E d t~ •E' i <br />NO. DATE TIME SAMPLE ID `F micromhosrcm __ y rn _ __—.- -- - ` -- '- l�l4,' <br />- ---- - <br />--- ---- t ( ✓ X .`� - <br />- -- --%- --- - i <br />2 — 7 --- -- - - - <br />X X _ <br />3 <br />7,12 <br />5 X <br />s1 3 -- -- — - -- --- - - <br />_ - <br />.- <br />x <br />l UI r <br />10 <br />121- <br />3 <br />J <br />— — - <br />-5dy: <br />— <br />' ' C Reli ature) Received By: (Signature) Date Time <br />NOTES MISCELLANEOUS Field/Container Temp. niRelinature) :11:0�eved(Signature) I <br />Date Time <br />Relinquished By: (Signature) Received By: (Signature) Date Time <br />I � i, <br />Container Sealed with Custody Seal: Yes ❑ No❑ — --- - _ . Date Time Received for lab By (Signature) Date Time <br />! - — <br />Description of Other Chains of -Custody Dispatched By: (Signature) <br />Method of Shipment p / <br />Transport Container Transported with this <br />f Chain (by Serial No.) ( r/ ,y <br />(.� . (.� ✓ ) J ' <br />e <br />!i (Check Office BeIOW) Verbal i Requested: Yes �, No F1Send Lab Results to (Name): //�i� f ��"' �" <br />VIEW • 441 NORTH WHISMAN ROAD, BLD. 23 • MTN VIEW, CA 94043 •7EL (415) 960-1,640 !FAX (415) 960 0739 �v <br />SERIAL NO. �•' MOUNTAIN r �� <br />PLEASANTON • 7901 STONERIDGE DRIVE, SUITE 100 • PLEASANTON, CA 94589 • TEL (510) 463-''9117 FAX (510,463 2981 ' �5�� <br />(r 1 <br />TEL FAX . I v j' <br />"0' � .L �-_� OTHER _ ; s i; REV. 9/95 <br />W) 111 E: Field Copy YELLOW: Projcr,t Copy PINK: Laboratory Copy <br />E � i, <br />