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Redwood City Water Quality Monitoring Program Plan Surface Water Sample Collection Chain of Custody Record © 2014 DKF Solutions Group, LLC Page 35 of 41 Customer Name  Hazardous Waste PO# Customer Address  Unknown Material WO# Customer Telephone Mail Code CONTRACT LAB INFORMATION Turnaround Requirement Program Name Ship to:  Normal (21 days)  Rush:  Other: Lab Program Coordinator Phone # Ship Date: Sampled By Courier: LIMS# (Issued by Lab) SAMPLE COLLECTION INFORMATION # Containers <br />Matrix* Analysis Requested QA/QC Requirements Date Time Type Sample Location Field pH <br />Field Temp <br />Ammonia <br />Enterococcus Lab Standard  Special (see attached) Composite <br />Grab Remarks/Notes   Upstream 2 A        Entry Point 2 A        Downstream 2 A        2        2        2        2      *Matrix: P = Potable Water, W = Wastewater, A = Ambient Water, G = Groundwater, S = Soil, B = Biosolids, I = Industrial, O = Other (specify in remarks) Relinquished Date Time Relinquished to Date Time Transport/Shipping Information  USPS  UPS  FedEx Tracing #:  Other: Sample Receiving Documentation Container intact?  Yes  No Correct container?  Yes  No Field preserved?  Yes  No Custody tape intact?  Yes  No Cooled?  Yes  No Temp. Blank?  Yes  No ( °C) Comments: Sample distribution:  Lab bench  Ice chest  Walk-in cooler shelf # Disposal Date: Disposed by: (inits.) C-O-C Distribution Date: By:  Lab Admin File  Prog/proj Mgr.  Lab Prog. Coord.  Delivery courier  Pick-up courier 6.2.A. - Page 201