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St 2TJOIA ANALYTICAL SAMPLE IIECE 113T ILOG <br /> r <br /> ' G`1.lF Ti5lhblR. <br /> TWIT.t'tL'C'D AT LAI,: 3h 9 1]rinkinl;Mater for v <br /> RI--.0 BY(PR1I+i'I') TZJ ,Jg("1)AT LAB. = f i egulatory purposes YES l 1 O <br /> ;'[1itYCOltilbk• <br /> DATE I.OGGFDIlt Was(cnaterfor <br /> i egnlatory purposes: Y1E:8 NO " <br /> i <br /> Ci(RCI.L''11EV,A1TR01'RWfL1US1'ONSL IJAB I)Agfl COIN7AT"R PRF.SBR SAI4I1'I..I: DATE REMARKS. <br /> CLII;h`T ID <br /> SAMPLR# # 1)l.Rf.'1tiY'1'ION 'VNI'M MATM 9AAVI�;D CONDPfION(ETC.) <br /> allo <br /> 1 Custody Seal(s) 1'resenf A sent (,�}— pQ F'IC L 3 If a <br /> Intact/13ra en* L <br /> 2 Chan-of-(:ustpd 1'rescti Absrnt* �� <br /> 3.Tratllo RcpotU or a <br /> pac!ks Lul 1'r00cn4Absc!il PS- --� <br /> ' 4 Atrbfli: Aubttll Sticker 0 <br /> PresentAbsen 6;V <br /> S AirbsIl# - _ S <br /> 6 Sample labels P ent Absent <br /> 7 ,Sample IDs. rste of Lssw I —9m - <br /> onChain-of-Custod• Cl <br /> 8. Sample Condition: 1 Ise, 1Brnken*1 <br /> * o <br /> 9. Doan hifaamntion on � <br /> custody reports,tre#Iic V1 <br /> reports and sample <br /> labeh a reel es NO: . <br /> 10 Sample received willua <br /> AeN <br /> { hold hnte: Yes Nom <br /> 11 Proper PFm enatives o- <br /> used Yes f I�Fa* <br /> t 12 1 a np Hoc at Laic � <br /> Is temp $+f 2°C� es No; <br /> (Acccptanecmngc forsamples tequ1rtng thermal pits) <br /> **Rxceplion(if any)' Metals 1 bPP (D3roct From meta) <br /> o� Prablcm COC <br /> X11?CIRCLED,CONTAG f PROJECT AMINA.G I It AND�,�"�'ACH RE CORD OF RESOLUTION, <br /> � Sempta Receipt Lop - - - - ...~..! <br /> ftvesron 3(63118103) <br /> Reptacos Revialon?3(12NM2) Page of <br /> Effedilve 03/18103 <br />