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04ARCADIS (D#: CHAIN OF CUSTODY & LABORATORY Lab Work Order <br /> ANALYSIS REQUEST FORM Page_of_ Cf V"7 <br /> Contact A Company Nanx Te�ePlr.irn <br /> O L /� Pnsarvaiive Keys <br /> S % Fiaared(,) Preservation Key: Container Information Key: <br /> A H,SO' 1 40 ml Val <br /> ���C� l�SHQF aaftC� /•I aorconr,iner: B HCL <br /> wire r�r •`^ I 2. t L Amber <br /> Ir C�Ulw , C HNO 3 250 ml Plastic <br /> D. NaOH 4 500 ml Plastic <br /> � Inrorrnatlon <br /> m <br /> C,-.y dale Zm E—,1Addrese PARAMETER <br /> �� � ANALYSIS $ METHOD E. None 5. Encore <br /> llr. F. Other: 6. 2 oz.Glass <br /> CAN <br /> „ CRtL" G Other_ 7. 4 o.Glass <br /> , <br /> Proicct NameiLocalron(City.Stahl Protect e- . 8 8 oz.Glass <br /> H <br /> _ Other 9. Other. — <br /> Samplers P-1-Namet3pj sampler~s n:dnr. •�0 �� Matrix Ke 10.Other, <br /> Lr� v 4l/� SO-Soil SE-Sediment NL-NAPL/Oil <br /> W-Water SL-Sludge SW-Sample Wipe <br /> Sample ID ollection Type(✓) Matrix T-Tissue A-Air Other <br /> � �N <br /> Date Time Comp Grab REMARKS <br /> G� 0 51 1630 S Y. 00. �.�. <br /> - I a- os <br /> o <br /> v6 , <br /> ( <br /> . i <br /> ('1 ® <br /> � 1 _ <br /> el� � <br /> s <br /> Special Instructions/Comments: 17 ❑Special QA/0C Instructions(-): <br /> UAq- MY416(fE �ES <br /> A <br /> Laboratory Information and Receipt Relinquished By Received By Relinquished B <br /> Lah Name. q Y Laboratory Received By <br /> JJCooler Custody Seal(.1) Pnntedpti..� PnntedNmne 1N►, � N Prmted Nnmc Pnr • Name•^ <br /> ❑ Cooler packed with ice(✓) ❑ Intact ❑ Not Intact Sana e. U Signal—, s; <br /> pnaNre Sg7pAtur� " <br /> S"aN Turnaround Regrnrements. CCS <br /> Sample Receipt Fa Fl�nvconn�r <br /> 1 j FirnvCouner <br /> Shaping Tracking a ,•/j�atM�Y^`S Fir ' <br /> Condition/Cooler Temp: oataRri+a <br /> 10 O \� oaten oalemme <br /> cats Tn e O <br /> 20730826 C&CAR Farm 08.17.2o1115 Distribution: WHITE—Labor ory returns with results YELLOW—Lab copy PINK Rel'ained by�LWif3 Of 26 <br />