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SAF-RC-047 100 & 300 Area Component of the ... - Hanford Site

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Lionville Laborato ry Use Only Custody Transfer Record/Lab Work Request Paget <strong>of</strong> <strong>of</strong> lu^ LI<br />

Est. Final Prol. Sampling Date<br />

Project # !^ l-,yl _^^/^rJ- <strong>of</strong><br />

Project Co rdacUPtwne #<br />

Lionville Laborato ry Project Manager<br />

QC Del ^T d TAT<br />

Date Recd Lk •d s o(, Dale Due .^/J 71 '/rt'-"<br />

MATRIX<br />

CODES:<br />

S- Soli<br />

SE • Sediment<br />

Letr<br />

ID<br />

SO - So li<br />

d<br />

SL • Sludge<br />

w - Wafer<br />

O- oil<br />

A - J it<br />

DS- Drum<br />

Scads<br />

OIL- Drum<br />

Liquids<br />

L- EP/TCLP<br />

Leschele<br />

an • wipe<br />

X • O<strong>the</strong>r<br />

F- Fish<br />

Client ID/DaaMpllon<br />

FIELD PERSONNEL: COMPLETE ONLY SHADED /AREAS<br />

See S<strong>RC</strong><br />

/^ m<br />

u<br />

Refrigerator #<br />

#Mpe Conminer<br />

volume<br />

Preservatives<br />

ANALYSES<br />

REQUESTED<br />

Liquid<br />

So lid<br />

Liquid<br />

So li<br />

d<br />

c<br />

ac<br />

Chosen<br />

d"<br />

Date Time<br />

Col le<br />

cted Collect<br />

10 to lJ1116V 1I 1 1. 4 I'll<br />

Special Instructions: V'VL =CQn', lic"A\¢,L DNS:<br />

^l'^YTL^I p t^L<br />

mC^cy15 , PCQ , Si^OC . *<br />

`l-d^4^ cto.Dw `''`.r3, aY. le.-Pes^^ z.<br />

Me- A-CJS PCB, PCIA, SVOCL . K'<br />

ReanquleMd Roe~<br />

by r by<br />

Onto<br />

Time<br />

1,1<br />

3.<br />

4.<br />

>I a^=lal III<br />

j LloWlis Laboralory U se<br />

X,<br />

r/<br />

Re linquished wed<br />

by by<br />

,.;QMP0.sjJ 0 f<br />

WASTE"<br />

CD<br />

CD<br />

J ^I•^^^ /^Jr<br />

Dale Time

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