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AARCADIS 1D# CHAIN OF CUSTODY & LABORATORY Lab Work Order 9 <br /> ANALYSIS REQUEST FORM Page_of_ Ct�' <br /> nne j—( <br /> contact n company Nan,.e Tel.:ph <br /> L <br /> Keys <br /> qw Pnservaliva <br /> SF;aere4I.) Preservation Key: Container Information Key: <br /> AJ.4�•>� Fae A H SO, 1 40 ml Vial <br /> m r �ctt£�csi41F <br /> �"eY6 r of cont.— B HCL 2. 1 L Amber <br /> lnl <br /> K ormetion <br /> C HNO 3 250 ml Plastic <br /> 2w2wcontainer D NaOH 4. 500m Plashc <br /> m city si•,cr ter emaaAnnresr. — E. None 5. Encore <br /> u� 7A1�� PARAMETER ANALYSIS & METHOD F Other s 2 o Glass <br /> Ro5Vt� scof.Aac*4 " drf��rxa G Other 7 4oz Glass <br /> Protect Nawil-ovation tC,ty.Staiel Protect e 9. B oz.Glass <br /> •MSO - H Other 9. Other <br /> Sampler-s Printed Name: sampler'r.si nan;n vW e 10.0ther-SO . <br /> LI, v 50-S Key: <br /> l/L � of SE-Sediment NL-NAPUOiI <br /> W-Water SL-Sludge SW-Sample Wipe <br /> Sample ID ollectlon Type(✓) Matrix f1-*I,- N T-Tissue A-.Air Other <br /> Date Time comp Grab x REMARKS <br /> f,-101-1o0S1 1630 S Y. Do <br /> Wc- Ib - 00, <br /> 0,, <br /> we - 0 �c+ <br /> r <br /> It <br /> � o <br /> , z <br /> Speeciaall InstructionslComments: El Special QA/0C Instructions(.): <br /> A <br /> Laboratory Information and Receipt Relinquished By Received By Relinquished f3 <br /> q Y - Laboratory Received By <br /> ah Name Cooler Custody Seal(✓) P oma Pw•,,„i N.n m Pnraee N,n, i P.. Name <br /> � �U�,ll E Itvl,vutJ � <br /> ❑ Cooler packed with ice(+) ❑ Intact ❑ Not Intact SOna e <br /> 5+0nan;re snoae,re <br /> sgpan, L <br /> Spociry Sample Receipt <br /> F,, Conner F <br /> Sh pp nW Trackinq a <br /> — Condition/Cooler Tempoatdrf O oatemma I <br /> 207]0826 colic AR Forrn08.27.2016 Distribution: WHITE—Labor ory returns with results YELLOW—Lab copy P NK Re(�ained by 0 <br /> �'af�'�3 of 26 <br />