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MViV • � <br /> Y � �� <br /> 210 es Sar1_k R 281- $OP <br /> s10honeP O Box 230 (618)281- Fax COC Serial No. <br /> Columbia, IL 62236-0230 (618) 281-8933 Bulletin Board 13 7587 <br /> Pro ect Name d--t 4 r� h S Pro ect Mgr <br /> ry/ m Analyses by Method Name and Number <br /> Project Number Phase•Task c �! <br /> v , Temperature upon <br /> Reciipti-I- <br /> Sam lar s /7�i /`?i �w e� d Matrix c ✓ �_ u,,µ f <br /> Laborata Name 4— ,� >< E <br /> ry o •. = c to = �` �� nl <br /> Location N Q 3 <br /> Sample Number and(depth) Date Time C 4Q Comments Field PID Lab ID#'s <br /> u <br /> M/} <br /> r 4 - �r� �S frZ ���� ✓ �� ✓ �� Y�r Yy M1S <br /> F <br /> too Flu 130d <br /> C,-? C — a A /S 41z,Z' 'S111 ✓ � Y ;a Qr <br /> �- ... Z r9 Z Z f& 110 V �J �✓ tJ ✓ <br /> (7e) <br /> 0—T 7z hz l6 3 ✓ ✓ �✓ ,� s ���� � <br /> -r- c z O 20 l �/ ✓ t/ ,✓ � <br /> c - — :3o <br /> ,� ✓ ✓ ✓ ✓ � � � �, <br /> PT — r 3(D /0 / 6' .. ✓ � ,i ✓ " � '1- f <br /> o <br /> c <br /> z-3 /0 '30 ✓ ,✓ ✓ ✓ � ` r <br /> Samples (iced ❑Yes ❑ No Lab Directives <br /> Preservatives (ONLY for Water Samples) Requested TAT ❑ 1-3 Days ❑ 5 Days ❑ 10 Days ❑ Other <br /> ❑ Volatile Organics Hydrochloric acid (HCl) Fax and/or Mall Results to <br /> ❑ TPH(8015) Hydrochloric acid (HCI) Send Invoice to <br /> ❑ TPH(418 1) Hydrochlonc acid (HCI) QC Deliverable Requested ❑ Results+QC ❑ Level 3 ❑ Other <br /> ❑ Metals Nitric acid (HNO3) Special Guidelines <br /> ❑ Cyanide Sodium hydroxide (NaOH) Reporting Limits <br /> ❑ Other(Specrfy) "Special <br /> Shipping Relinquished by. Received by <br /> Carrier/Airbill No Signature Date Time i nature Date Time <br /> ' 1030 <br /> 6 ! �rii zw <br /> "v /goo <br /> Distnbulion WHrrE to Lab CANARY to PM PINK to QA/QC GREEN to Sampler Lj Shaded Areas to be Completed by Lab <br /> PE 179(3/96) <br />