NCG120034 DMR SW (3)

Research & Analytical
Laboratories, Inc.
Analytical /Process Consultations
Phone [phone]
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CHAIN OF CUSTODY RECORD
Wa
ter
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Wastewater
Misc.
Company
Job No.
City of Winston-Salem
Street Address
Project
101 N. Main St.
Old Salsbury Landfill
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City, State, Zip
Sampler Name (Please Print)
Winston-Salem, NC 27101
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ContactPhone
Sample nature
John S ainhour
747-6965
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11/09/15
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11/09/15
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Outfall' 6'
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11/09/15
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Outfall' 7'
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11/09/15
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Outfall' 8
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11/09/15
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Outfall' 9'
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COD, TSS, Fecal Coliform*
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Outfall' 10'
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COD, TSS, Fecal Coliform*
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11/09/15
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Outfall' 11'
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1
1
1
COD, TSS, Fecal Coliform*
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lin wished By
Date/Time
Received
Remarks: Analyze Fecal Coliform sample up to 60,000 cfu/100mL
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Analytic ampling Old Salsbury Landfill- All Grabs
Relinquish By
Date/Time
Rec v d By
on fee Sample Temperature at receipt °C