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<br />© 2004-2014 DKF Solutions Group, LLC. All rights reserved. <br /> <br />El Dorado Irrigation District: Overflow Emergency Response Plan C-2 Field Sampling Kit <br />Sample Collection Chain of Custody Record <br /> <br />Customer Name  Hazardous Waste PO# <br />Customer Address  Unknown Material WO# <br />Customer Telephone Mail Code CONTRACT LAB INFORMATION Turnaround Requirement <br />Program Name Ship to:  Normal (21 days) <br /> Rush: <br /> Other: Lab Program Coordinator Phone # Ship Date: <br />Sampled By Courier: <br /> <br />LIMS# <br />(Issued by Lab) <br />SAMPLE COLLECTION INFORMATION # Containers Matrix* Analysis Requested QA/QC Requirements <br />Date Time <br />Type <br />Sample Location Field pH Field Temp Ammonia Enterococcus <br /> Lab Standard <br /> Special (see attached) Composite Grab Remarks/Notes <br />   Upstream 2 A      <br />   Entry Point 2 A      <br />   Downstream 2 A      <br />   2      <br />   2      <br />   2      <br />   2      <br />*Matrix: P = Potable Water, W = Wastewater, A = Ambient Water, G = Groundwater, S = Soil, B = Biosolids, I = Industrial, O = Other (specify in remarks) <br /> <br />Relinquished Date Time Relinquished to Date Time Transport/Shipping Information <br />  USPS  UPS  FedEx <br /> Tracing #: <br />  Other: <br />Sample Receiving Documentation <br />Container intact?  Yes  No Correct container?  Yes  No Field preserved?  Yes  No Custody tape intact?  Yes  No <br />Cooled?  Yes  No Temp. Blank?  Yes  No ( °C) Comments: <br />Sample distribution:  Lab bench  Ice chest  Walk-in cooler shelf # Disposal Date: Disposed by: (inits.) <br />C-O-C Distribution Date: By:  Lab Admin File  Prog/proj Mgr.  Lab Prog. Coord.  Delivery courier  Pick-up courier 6.2.A. - Page 163