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Billing Information: Anal sis / Conta ner / Preservative Chain of Custody Page of <br />PreS <br />Chk 1:1' <br />--÷ <br />VI <br />ceAnalyticar <br />..... CAntor e, darn, a <br />Report to: 1"-t‘ 04 Lel ‘n.h.N. it. tf <br />Atv Niptr 1?-otstive• <br />Email To: tA tIsree;,I t.p ir,h- beidttki A_ <br />/4Pestalt hk,#st-t•i_cs‘bt .tuvr, <br />:-3 12065 Lebanon Rd CII. . CI mo..iulvet, TN <br />758.58 <br />37122 <br />Rho ne: 615.58 • ..4, : <br />Project Description: (te,;yti‘ ilk 0141 C ty/State 'Jt- - (*.I'M% C_ A Collec-ted: * <br />Please rcle. Ci <br />PT MT CT ET <br />- - <br />..-.1 <br />Phone: a00-767-5859 <br />Fax' 615.750.5859 <br />'- • <br />,SDH-TrtkkiSilfAre. <br />Phone: <br />Client Project A <br />0 1 (P2-743 <br />Lab Project A <br />C-C- t J rt....,.. --1.- <br />, ..... N <br />7 SDG* <br />D08 3 <br />Collected by (print): <br />At 1", Son ICI rk rve-3 <br />Site/Facility ID A P.O..... ...1 <br />..— <br />th.) <br />a% .. _ <br />..) <br />_t- <br />— <br />Accutum: <br />Colle ed b (signature): Rush? (Lab MUST Be Notified) <br />Same Day Five Day <br />Quote # <br />LI.- <br />CD () <br />i <br />Template: F, <br />iS <br />Prelogin: <br />Immediately <br />L= <br /> <br />Newt Day -5 Da/ I Rad Only) Date Results Needed <br />X Two Day 10 Day (Rad Onl.,1 <br />ay Three D _____ of 0 el <br />c...) <br />, <br />VI <br />L-ro^ 4 0 , PM: <br />PB: <br />Packed on Ice N pl. .. - ‹ 4 <br />ell Time ''''''s 0 1"- C.) Vi Shippeda: <br />Sample ID Comp/Grab I Matrix' Depth Date I cy, <br />i t) kg r-- \ Remarks Sample a (lab only) - -------- • ----- • <br />1-.‘r4.-.2.-1.2.4 2.15Z° CAsia..%s Wei tke 1-24-2.b2.3 1116. - -IX ‹,<1.4 A HH1-11-1 <br />1.74.2est, 15`53 L3 1. x It it 14 i4 IA 1-4 A , (D 24 - 21- 5S2q- Ek) Sr:1 <br />1 <br />1 <br />' Matrix: <br />SS Soil AIR - Air F - Filter - <br />Remarks: 4 --= T4olci pH T e mp coc Seal . res241.121Le-!intitse Y It <br />GW - Groundwater B - Bioassay <br />WW - WasteWater Flow Other <br />' CCIC Sign /A . t • • - <br />Bottles Joe' isitintt - <br />OpYrect las -7i, tt nerd; N <br />OW - Drinking Water Samples returnedvle: ..---....1 -..ii. Stiffici volume seatt <br />, OT - Other UPS FadEs "4-------;-, 0 Az uoiicabla. <br />VOA Zero!lieadapileor ' ' <br />Reim uish d by : (Signature) Date: <br />-4 .21t2,0 2.0 <br />Time <br />i 1 Za <br />Received by: (Si nature)_ 2 _ <br />— ./,....0, ----- ,.. <br />Received: Yes / Ca Ha / macH <br />Proservation Correct/Clucked: <br />SAD Scre4p S'Iatili vILts . <br />i <br />Reli Llsheci, ignature) L--/K- Date: --7 _2-)-2oz c Time: i i : co <br />Recelby: (S' <br />T.* / <br />ttl <br />ll <br />Baes Received: If preservabon requires! by (Atm Oaten . •. . • _. - <br />Relinquished by: (Signature) Date Time Receives( Wir by: (S <br />_/....----- <br />Time: <br />7 ' 41.0 2 ?::‘, 1) 01W <br />Mb : <br />/