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Billing Information:
<br />. ? • --• - CL -
<br />Pres
<br />Chk
<br />Analysis Container / Preservative .Than of lustodv Page
<br />ce Analytical
<br />12065 Lebanon Rd
<br />Mount Juliet, TN 3 ./1..
<br />Phone 615 75S-5S
<br />Phone !CO-767-5859
<br />F. 615-758-5859
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<br />Email To:
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<br />oject Descriotion:
<br />-1, I ":0>:-A._ •?k ,._%._
<br />Cty/State \ _ 4-n4 1,,,. ?,
<br />Collected: (...A-
<br />Please Circle:
<br />PT MT CT ET
<br />SDGtt 1,I 2011 one :
<br />M ‘o --S 9 3_ S-3---7--.--r
<br />Client Project 4
<br />lk- 21- e,"01-3.-1
<br />Lab Project 4
<br />11- -t._ t - AJD (-3 -I G203
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<br />Acctnum:
<br />Template:
<br />Prelogin:
<br />PM:
<br />PB:
<br />.flected by (print):
<br />7 ) . -/\ \ —k-LA
<br />Site/Facility ID 4 P.O. 4
<br />5 l . -2. t • cr-c, + -3 4
<br />dlected by (signatl]re):
<br />1
<br />i
<br />Rush? (Lab MUST Be Notified)
<br />same Da,, X Five Day
<br />Quote #
<br />mediately
<br />cked on Ice N >'-'
<br />Next Day _ 5 Day (Rad Only) Date Results Needed
<br />Two Day 10 Day (Sad Only)
<br />Three Day
<br />No.
<br />of
<br />Shipped Via:
<br />Sample ID Comp/Grab Matrix' Depth Date Time Cntrs
<br />R,rla•ks >ar^pio /I flab onl,
<br />‘ CE -10 <?3, c..,,,-.--y -) • ks .1. I, 77 .;.• ,
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<br />e1atrix:
<br />-Soil AIR - Air F - Filter
<br />Remarks:(L 3/44 \ 6i_i .ci..._ -1-1...\ A_Ni ----.3, \ ,-rpv4 . ott. 2:-. 50 , C.Ot`' e, 5.
<br />i)t,EW> <7.._,....._.) eit%.„ F. x s \-i, 131, . 2- k o . .-- m L. PH Tem.;
<br />$argale Receipt Checklist
<br />COC Seal. Present/Intact: UP ZY N
<br />COC Signed/Accurate: .4 N
<br />Bottles arrive intact:
<br />bottles used:
<br />-;t --N
<br />--,At --N Correct
<br />Sufficient volume sent: --.7kr --N
<br />;f Anplicable
<br />Groundwater B - Bioassay
<br />N- WasteWater
<br />2 .
<br />1._Eitt-i 'e,rx-I ....$ S.-.),._ C.-J-1 IT) . c-:".--, ''Flow Other
<br />J - Drinking Water
<br />-.) '' 1 ''' ° '-"... -Other A-15 5) 1-1-1',v v-v•-• -
<br />Samples returned via:
<br />FedEx /. 51e1 ri... _UPS _ _Courier --- TThrac. king:
<br />VOA Zero Readspacet Y N
<br />Preservation Correct/Checked: N ui e (Signature) D:re
<br />I ..1 1
<br />T:me:
<br />f -ti 3
<br />Received by: (Signature)
<br />-'.
<br />".01{...L.+6
<br />Trip Blank Received* Ye
<br />Hsk;eoH RAD screen <0 .5 laR/hr: Y N
<br />I, inquishe b :)Signature)
<br />- -----* ----,.....r----
<br />Date:
<br />--3 — K"' —if'
<br />Time:
<br />7 5-2 f---
<br />Rece:ved b \:• (Signature Tem c Bottles Received:
<br />-0120?__49 2., _
<br />If preservation required by Login: Date/Time
<br />linquished by : (Signature) Date. 7 ' r-e. Received for lab by: (Signature) Date: / / -fin
<br />-... .....0" 3,404 ila el
<br />Hold: Condit
<br />NCF /•
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