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yV.E. T. InG <br />Waler.~ EnvirortmenmlTesHnrlnc 235 Wesl~00Saath.Arher(can Fark. Uta/r 84003 (8011763-0660 F¢r(80U7b3-(J440 <br />f~ <br />U <br />~~ <br />Chain of Custody Record <br />t,ve~ rs.~.v. vv_S ~)~.p <br />Customer. (.~,,~ zu ~ ~ Sampler: ~ ~~ , ,_ ~ <br />Sample Date: 7L: ~_ r-, , ~ P-b1~ <br />Samnee Information <br />Sample # Date Time CompositelGrab Location Analysis Requested <br /> u J~e,~lr <br /> <br />• ~, <br />,z,y-rte luppes oa7 wtT rsz' ~.g -c <br />~4 ~ v~~o; <br />z~ G ,ua7~s~ ° <br />~.~^ Nveer ~sT~/~ac <br />~~ <br /> <br /> <br /> <br />Samnle Cnstodv Rernrd <br />Re ~ --'-'•^~ ~ Received by: <br />/ <br />~S Date(Time <br />• 1 <br />Relingaisbed by: Received 6y: Date(Cime <br /> <br />Relinquished by: Reoeir DatelIlme <br /> <br />Sample Rece~ ed is I.ab 6y Da e <br /> <br />Temperature Received in the Lab: Effluent: ~, Q~ `G (Sb-7 <br />Receiving Water: ~~ ~ rG 6'p8 <br />Gaoler: w« ~«~_ F4ad odivtr7 <br />w.E.T, iac CoarKr_ <br />Slat ice_ Sldpped~ _ <br />Neat <br />e..tea is sr~c.c s...~ <br />C~jrLYdN (bslad~SuklfudYv <br />Sukd. ~Ii/NA [atau Y/N <br />Samples- <br />OOC and Ci6da Malc6T <br />Ya _~ <br />No _ <br />IBfvlota/Lnldar? Cbertd UsoT. ShciBms QaaaQry ~~+~rQ~7~ <br />Yes Ya Smapk! Reei3Na= Watert <br />Na V. No Yes ~ Ya <br />/- No No <br />S,n.~n nc~s <br />