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Ilecldel Ilan ford Inc. CHAIN OF CUSTODY/SAMPLE ANALYSIS REQUES T u9a-Obi-ul 1''b` !
Collec for Counpauy Cnulocl 'I vlrphone No. Project l'unnlblalur I).Ia I or'us roond
It I uhiber8 slave KSnu.ske 171-4116 VVV.1.SX, Ill.
foujoel Designation Sampling Location
105-4' Phase I & Phase II -Concrete samples
100 Area `
AFNo.
1.—d)73
lu Chest No. Fi eld Logbook No. Method of Shipment
_ Iland deliver
hipped To ORaI(e 1'rnperty Nu. IIIII of Ladil KIA it 11111 No.
Qumncrra Incorporated N ^f- N 3f
POSSIBLE SAMPLE HAZARDS/REMARKS
RWlaanva
pedal Handling and/or Sto rage
A03^1 Sol /1 WmI
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SAMPLE ANALYSIS
Preservation
Type of Container P
21 Days
No. of Conlaiucr(s) 7 _.
Volume
IL
Sn ium I , In
I^^"^`I^°^•
"'"o,
sample No Matrix • Sample Da te sample'l imc ^`, ^", ', {^. ' 3g{ payenn '^ k 9 d 1
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CILUN OF POSSESSION Sign/Print Names
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ioquishcJ By Dwcil ne Received By D.ICIFimc
IAIIOIIATORV
SECIIt1N
FINAL. SAKIPLE
DISPOSII ION
SPECIAL. INS'fRIICI'IONS
I ICP Mail. - 6010A S,, nuce Leal ' Merco 7471 - CV Chromium Ilea 7196;
NCB. - 8080 1Aroclor-13341; Gamma Spearosoupy IC.s om-137. Coba1660, Earopiwm 153,
liuopiwm 154. Luopiow 1351. A... oral-741; 1.°mpic Plwmmun; bolapie Unnlmn: S ol e
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