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Company Name/Address: <br />Alternate billing information: <br />Ana <br />Receive y: (Si tura) <br />Received by: (Sign <br />Sa ples retumed via: p UPS <br />edEx El Courier <br />Preqp <br />Date: <br />Time: <br />04-0107 ie ofC oft1 <br />/ <br />SVG E/w1/ o n mo (nC <br />M <br />Prepared by: <br />Avt- <br />Time: <br />� A <br />Dat : <br />Time: <br />pH Checked: <br />s <br />S�a,• Ca, -105 " G4 9`f0%a <br />ENVIRONMENTAL <br />SCIENCE CORP. <br />I�-f <br />12065 Lebanon Road <br />Report to: <br />s5 ,nlr`n�� <br />mail to: <br />toss V_ Cory-, <br />I <br />" <br />Mt Juliet, TN 37122 <br />Phone (615) 758-5858 <br />Phone (80.0) 767-5859 <br />Projectrity/sate <br />Description: Sr7 - M7 II S� W . T <br />ollectd T <br />Phone: (oS'11M <br />Project #: <br />ESC Key: <br />FAX (615) 758-5859 <br />FAX: <br />— Z <br />�O <br />b0 <br />' <br />A045 <br />Collected by: <br />�oss T <br />Site/Facility ID#: <br />P.O.#: <br />ask, y93190 <br />�' <br />j <br />k;; <br />-- <br />I CoCode {lab use only) <br />Collected by (s' nature): <br />Rush? ( Lab MUST Be Notified) <br />Same Day 200% <br />Date Results N ed: <br />_> <br />St <br />No. <br />....... <br />Next Day........ 100% <br />t <br />'�j� <br />TBmplate/Prelogin <br />Email? es <br />Immediately / <br />° <br />Two Day........ 50 /o <br />_No_ <br />ZNo <br />o{ <br />Si �- <br />Packed on Ice N Y V <br />- — <br />Three Da 25% <br />FAX? Yes <br />Cntrs <br />;+- <br />41Shipped <br />Via: <br />....... <br />Sample ID <br />Comp/Grab <br />Matrix` <br />Depth <br />Date <br />Time <br />j <br />RemarksJContaminant Sample # (lab only) <br />Its <br />y� <br />_ ds� <br />r <br />19 <br />- <br />G <br />3• oc� <br />i <br />I <br />'Matrix: SS - Soil(Solid GW -Groundwater WW - WasteWater DW -Drinking Water O r, <br />Remarks: <br />I t �/ <br />pH <br />Flow <br />Temp <br />Other <br />S urgL <br />r <br />*Relinqui <br />D e: <br />/0 <br />Time. <br />y� <br />Receive y: (Si tura) <br />Received by: (Sign <br />Sa ples retumed via: p UPS <br />edEx El Courier <br />Condition: (iab use I <br />j� y <br />tr/✓! <br />Coc Seals Intact— Y .T N NA <br />Date: <br />Time: <br />e <br />t3ott s�f?ved: <br />by: ( ) <br />Date: <br />Time: <br />Rec ived for lab by: (Signature) <br />Dat : <br />Time: <br />pH Checked: <br />NCF: <br />p O <br />