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ENVIRONMENTAL PROTECTION AGENCYOffice of Enforcement CHAIN OF CUSTODY RECORD

REGION 6First Inttrnational Bldg , 1201 Elm St.

Texas 75270PRQJ. NO. PROJECT NAME

SAMPLERS:

STA NO DATE TIME STATION LOCATION

NO

OF

CONTAINfcRS

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002569

ENVIRONMENTAL PROTECTION AGENCYO'fic* of CHAIN OF CUSTODY RECORD

REGION 6Pint International BlJg , 1201 Elm Si.

, Te«« 7S270PROJ. NO PROJECT NAME

SAMPLERS

STA. NO DATE TIME STATION LOCATION

NO

Of

CONTAINERS

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303 -i

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002570

_—• •- f« k-X^-'-.- N——• -n'. Scenpie N jnb^r

REPORTT) Oae Muxnbar:

Sample Site Na««/Code:) SAMPLE CONCENTRATION^ (Che«rlt One)•"•"—— Low Concentration

Medium ConcentrationSAMPLE MATRIXs (Check One)

• WaterSoO/Sediment

Sampling OflSoo: -iLi-____Sampling Personnel:

^Pc£ldU^

Ship To:

Attn:IVenelerShip To:

Sampling Date(End)

(9) Shipping Inlonnation:Name Oi Caniei

Date Shipped _Airbill Number:

(Check One)Surface WaterGround WaterLeachateMixed MediaSolidsOther _____

ITCHES ORGANIC SAMPLE NO

B) Mark Vohune Lvr«iOn S*«pl» BottleCheck Analym required

J/TOUI

ANALYSIS LAB: /c.db-Reed by

Date Reed

Sample ConditionOR Receipt:

[eg broken leakage, chain o( custody, etc

LAB COPY FOR RETURN TO SMO

T

002571

Cwa Number: _Sample Sit* W*m»/Cod»

Sampling Personnel:(Name)(Phone)Sampling Date(Begin) ______' (Bid)

Sample DeaoupUon:(Check One)

> Surface WaterGround WaterLeachateMixed MediaSolidiOther __ (specify)

MATCHES ORGANIC SAMPLE NO

SAMPLE CONCENTRATION(Check On«)

Low ConcentrationMedium Concentration

SAMPLE MATRIX(Check One)

WaterSoil/Sediment

(i) Shipping Information:Name Of CarrierFECDate ShippedAubill Number

(V) Mark Volume Le»elOn Sample Bottle

Anaiyiu required

0 Ship To

Attn:

Ship To:©ANALYSIS LABReed by .>' '

Date Reed

Sample ConditionOn Receipt:

ley bruken, Iti4krt>j" i.'haui of custtxiy. etc )

LAB COPY FOR RETURN TO SMO

002572

l) CasoNumber:Sample Site Kama/Coda:

Saxngtlxog Office:Sampling Personnel:

(Name)(Phone)Sampling Date:(Becrin) (Sod)

Samplo Deecriptsoo:(Check One)

.-Surface WaterGround WaterLeachateMixed MediaSob-isOther _________

TRROTC REPORT&jmpie NumberMFC 305

SAMPLE CONCENTRATION(Chock One)

Low Concentration— Medium ConcentrationSAMPLE MATRIX

(Cherk One)WaterSoil/Sediment

(a) Shipping Information:Name Of Carrier •.____TEC__Date Shipped; __Airbill Number: ^°

ITCHES ORGANIC SAMPLE NO

Marfc Volume LavolOn Sample BottleCheck Analysis required

Metala

LAB COPY FOR RETURN TO SMO

4 Ship To:

Attn:TVaiuforSnipToi

[•) ANALYSIS LAB: y^TTP^Reed by:

Date Reed:

Sample ConditionOn Receipt:

(eg broken, leakage custody, etc )

002573

|H @CMaMomfaflr. , , •. • jIHH V Sample Site Kama/Cede:BHiHHH - -- - - -HHiTJjrjj» (*) Sampling Office: „....£/-.. , „ ,B^Rli Sampling; Personnel:l&ii "7" f /'tffljjjSSi, (Mam«V /C*i'f • — ^XC////^-m^Ca <-, > i c/i- '- / *- jHgraagi iracmet •«•--' , -^r '*^ ,iT , .B^B: Sampling Date: Sil/flr»P (Beoinl /O^ IRadi /O2D

^H^ (Check One)Bg@S| ——— Surface Wateri||K —— £ Ground Water^HS ——— LaachatewHi ——— Mixed Mediai m1 —— Sohd:

Kffl| (apeeafy) .HB^TCHES ORGANIC SAMPLE tX) /^^r

0 SAMPLE CONCENTRATION(Check One)

——— — , l.ow Conrentialum—— *£- Medium Concentration0 SAMPLE MATRIX

(Check One)—— - Water———— Soil/Sediment

0 Shipping Information:Name Of Carrier

f£ <^S/T / S >Okite SHfpp*"' '

Aubi1' N«T«h«'" '/O ^/"2L / >/

0 Mftrk Volume LavolOn Sample BottleCheck Analysis required

0 Ship To:ft t '5. M ^// f '> , j- -5,1/^x ,. , . -, (,,-y , , /^/

Attn: /x /*v/ ^, / x , rfr/'vTransferShip To:

0 ANALYSIS LAB:y^ * f\*]^ffi*P^^i_rFl of rl nv ' *"^ ^4lr * t^^

jff^/y~J?fn9t«R*rri ^ ^

/^(l*>Sample ConditionOn Receipt:

(eg bruken. leakatje, i-hain ol rust(Hiy, *>lr )

( /CI/

JrLAB COPY FOR RETURN TO SMO

002574

T) Caso Number:Sample Site Name/Code:

Sampliag O£Ece:Sampling Personnel:

(Name)

(Begin) {End)

(Check One)Surface WaterGround WaterLeechateMixed Media>lids

Other __ (specify)ITCHES ORGANIC SAMPLE No

Sample NumlierMFC 308SAMPLE CONCENTRATION

(Check One)Low Concentration

—— Medium ConcentrationSAMPLE MATRIX

(Check One)WaterSoil/Sediment

(e) Shipping Information:Name Gi Camer

FEc9/7Date Shipped

Airbill Number: ) / O

\ Mark Vohund LevelOn SampEa BottleCheck Analysis required

Metals

Ship To:

TransferShip To:

(») ANALYSIS LAB:Reed by: _

Date Reed:

Sample ConditionOn Receipt:

(eg broken, leakage, chain of custody, etc )

LAB COPY FOR RETURN TO SMO

002575

Sample Number&**'*••*~*r

® Case Number ___J2TSample Site Name/Code:

($\ Sampling O&ce:Sampling Personnel:

(Pkone) ~>*Sampling Date:

(End)

(Check One). Surface WaterGround WaterLeachateB4ixad MediaSolidsOther _ (apedf?)ITCHES ORGANK; SAMPLE NO:

SAMPLE CONCENTRATION(Check One)

———— ~s Low Concentration• — -••- •*" Medium Concentration0 SAMPLE MATRIX

{Check One)——— £ Water- ———— Soil/Sediment

(a) Shipping Information:Name Of Carrier:

Dale Shipped:Airbill Number: *'*

Mark Volonw LerrelOn Sample BottleCheck A.nalyii» required

Metals

LAB COPY FOR RETURN TO SMO

Ship To:

Attn:

TVanrfarShip To:

(e) ANALYSIS LAB:.Reed by:

Date Reed:

Sample ConditionOn Receipt:

(eg broken, leakage, chain of custody, etc)

002576

Sompie Number307

SAMPLE CONCENTRATIONjCheckQneJ ,4 Ship To

O-Concentrationncentration

SAMPLE MATRIX{Check Otia)

WaterSail/SadbaiAnt , .

Information: ») ANALYSIS LAB:Raedby:

Data ShippedL. . '.<.-

Swaplo Condition

On Sample BoitloChock Analysis required

Mofia^ • ' • . .(eg. brokon, taakage, chain of custody, «tc.)

002577

Sample NurnbarMFC 308

i SAMPLE CONCENTRATION(Chock Om)

Low ConcwitrttionM*dbum Concentration

SftMFLB MATRIX • K> »«-K(Check On«)

WaterSoU/Stduwnt ..,- . . • •

4 Sh^To:

Atte:: LJLMO>Transfer

""SUpTo:Inlornuitioa: ANALYSISLAB:

PECj l ft Q-fg>/S >r ; * *r^^^^^r^^^^fc* ^^^ ' ^^"i^H'iT

Mark Vehuna L«««lOn Sample Bottl*Ch*dt Aualysu t*quu«d

OnReonpt:-i *>(eg bfokoa, leakage, cham o* custody, etc)

002578

MFC 306£>orapia Site Kama/Cad*:

SAMPLE CONCENTRATION(Check One)

,Low Concentration— — Medium Conc»ntr«tion

0 SAMPLE MATRIX(Check One)

.. -* A '.off" ( ipt- ;,-,;_•

Ship To:

Attm:

Infonnatioii: 0 ANALYSES LAB;Heed by:

Date Shipped:^AfrJMUNiuabeic. . 7 fft

e m*ect v •;. .j i -nj Ki - SunpittCooditioaOnRanipt:

(ogr broken. iMkago. ch«tn o* cuMody. am)

002579

Son le NumberMFC 305

.SAMPLE CONCENTRATION(Check One)

Low Concentration——— Medium Concentr*boo® SAMPLE MATRIX '^

(Check One)Water

r • • ; _ ,

Ship To:

Attn:TVaiufer'Ship To:

•). Shipping Information:

Matefe Vbioaw LoveiOn Sample) BottleCheck An*Jy»w required

©ANALYSIS LABBocdby:

Saxnplo Condition- On Receipt:(eg. broken, leakage, cham of cuMody, etc),,,, Ok

002580

umber

SAMPLE CONCENTRATION(Check On&}

Low ConcentrationMedxtsm Concentration

, l(@^5h*p To:

"-" t (Check One)

Shipping Irtformation:

(Check On&J Marie Volume Level • •: -On Sample BottleCh«ck Analysts raquirsd

, .MWJ»(JOO I* t

.,' oj n" vuq p}| no

Atta:1--' 1 Transfer

0 ANALYSIS LAB:Recdby: £•

Sample Condition •On Receipt: - ,-. hroksn, leakage, chain of ouatody, ate.)

CEWEHYr DIBECXIOM2 ''i

002581

SAMPI£ CONCENTRATION' ,«. v .(Check One)

Low CcccentrationiMedium Concentration

SAMPLE MATRIX ,(Check One)

Water

Shipping Information:^ $Ja£e Of Cariiar:

ANALYSIS LAB:Reedby:

Date Shipped:C( . '.-i .•• - Ji , * :« • * , '-,..,'> ..filNumber: /ID O/^ -'

Sample Condition

On Sample BottleCheck Analysas required

(sg. brofcsa leakage, chain of custody, efei)

#*S?BI5?WVT* fM&fET" f ?at**WE> /\*t&PuUDnI JJloc>V*Mt*i'UnrLc: x^oOu/-,-.M^TvC^ w

002582