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Billing Information: <br />Pres <br />Chk <br />A lalystS Cortainer i Pre5er:dative Chain of Custody Page of <br />Analytical ' <br />n <br />to <br />0/44 <br />Nem, :ci, Car., ,..., riaValal a t,...,..... <br />12065 Lebanon Rd 0 0 <br />mou,,t 10.3, TN 37122 . <br />Phone: 615.758.5858 • ' <br />phony. 800467-5859 <br />Far 615-758-585s 0 . <br />port to: <br />.....' TZ-v 1 t- '1.s'k- \ -1-1.-\ <br />Emad To. <br />.T>9.4% 11-(e N. q--rrz-r-"--c---sv ACZ*--) lict"1-#1‘4— <br />)ject Description: C ty/State --r-rt-ir-t---/ , <br />Collected: C or- <br />Please Circle: <br />PT MT CT ET <br />S <br />1 <br />,e"-\ <br />0 <br />--..., <br />0 <br />' <br />L--:- <br />‘,... <br />,---,. <br />_ <br />..r. <br />.) <br />° <br />,,,--"' <br />-.I, <br />tDG# / 5 05 Lt i u <br />H063 <br />Atctnurn: <br />Template: <br />Prelogin: <br />PM: <br />PB: <br />one: <br />TN.. 3'11- - %I-1.1 4- <br />Client Project a <br />t 1 • -2_1 . dzycz, b \ ---1._ <br />Lab Project a <br />1 I . -2-* • ‘20 C:, 1 -T._ <br />Ilected by (print): <br />,s-1 •-(1.4 <br />Site/Facility ID a P.O. a <br />I l • --1_1 • c.-C...C. k -7- <br />k <br />Ile . .y (sin (?t 1 u Rush? (Lab MUST Be Notified) <br />Same Day ."•• Five Day <br />Quote t$ <br />../0 <br />edi tel <br />ck . on Ice N <br />Next Day 5 Day (Rad Only) Date Results Needed <br />Two Day 10 Day (Rad Only) <br />Three Day <br />NC, <br />o' <br />(i),. <br />0 r• <br />.75 Shipped Via: <br />Sample ID Comp/Grab Matrix • Depth Date TI , M c n t r s <br />s......."4.. ....'j ''''''j Rernar,, Sample A OA only) <br />-J TL .----‘-t a_ ,............7 I . 2- .--z. ) -t. <br />, <br />— <br />a <br />ilatrix: <br />AIR - Air F - Filter <br />Remarks: <br />I3,- <br />§ample Receipt Checklist <br />COC Seal Present/Intact: NP /41 N <br />Zy _ <br />Bottles arrive intact: ZY N <br />Correct bottles used: .4Y ::x <br />Sufficient volume sent: LY N <br />Zf Applicable <br />V - Groundwater B- Bioassay <br />N - WasteWater <br /> <br />COC Signed/Accurate: ft <br />.,low Other <br />V - Drinking Water <br />' - Other CLG-C-k...- '5CA- <br />Samples returned via: <br />UPS FedEx _ _ _Courier Tracking* VOA Zero Headspacer Y N <br />Preservation Correct/Checked: Y N <br />RD Screen <0.5 mR/hr: <br />dinqui y : (S' a ure) Date: Time: Received by: (Signature) / . 7 _2 , /2 0 c. <br />'it_:-..e.e___--- ' uf---‘4..- <br />I <br />Trip Blank Received: Yes= <br />TBR <br />ding ih d by : (S. a ur <br />e-,,, d _....,....4„,„...-- <br />Date: <br />, - 8-- -2' <br />Time: <br />C : W ti 7 <br />Received by: (Signature) ( T . °C BOttleS Received: If preservation required by Login: Date/Time <br />7inquished by : (Signature) __.-- Date: Time: Rec lab by: (Signature) Date: <br />, \ <br />1 <br />Time- ,..., <br />771 K ( <br />Hold: C ndition: <br />/ OK