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12065 Leoanon iii <br />Mount Juliet. IN 3 11., 2 <br />Pnone 615-78.3R55 <br />Pnone. BOO- 761.5RY, <br />Fax 615.75858'.. <br />Depth Date <br />At.t <br />Time <br />_0•30A <br />ntrs <br />'‘K <br />Analysis / Container / Preservative <br />Pres <br />Chk. <br />Please Circle: <br />PT MT CT ET <br />Email lo <br />ClC5,114-AnP ?..-4--r,li 4 r,,, ec...)...a.a.-1 •Cat 01 <br />I <br />City/State \9, ,,,,, c4a, <br />Collected: <br />Lab Project Ii <br />Im iately <br />Packed on Ice N <br />Sample ID I Comp/Grab I Matrix' <br />55 Creni <br />in at curtail, <br />/ Place Analytical' <br />SOG <br />Tablc <br />Acctnum: <br />Template: <br />Prelogin: <br />PM: <br />PB: <br />0-0475— <br />D067 <br />Shipped Via: <br />SWriple# (,At, on r yl <br />Rush? (Lab MUST Be Notified) <br />Same Day 1,-F-1;e Day <br /> <br />_ __ Next Day 5 Day (Rad Only) <br /> <br />Two Day 10 Day (Rad Only) <br />Three Day <br />a_ ?)S <br />Biding inforrnatioi-ii <br />S <br />Client Project # <br />00 ,-.0e1 <br />Sitelf acility ID tt <br />Report to <br />S <br />Project Description <br />Phone: <br />ctU, 3,-C-2 Cs -7014 <br />Collected by (print): <br />4), <br />CcLbV (signature). <br />No <br />of <br />P 0 a <br />- <br />Quote # <br />Date Results Needed <br />LI <br />3;0 s,> ic,c. pH Temp <br />Sample Receipt Checklis <br />COC Seal Present/Intact: NP <br />COD Signed/Accurate: -f N <br />Hold Dr6 Condltk6,) <br />NCF / <br />Tracking # <br />Samples returned via: <br />UPS _ FedEx _Courier <br />r <br />Date <br />Date <br />£0 <br />Date <br />Received by: (Signature tme <br />/2:15 P <br />Time <br />T me R ved for la (Signature) <br />`Received by gnature <br />Tf Applicable <br />VOA Zero Headspace: <br />Trip Blank Received: Yes /& Preservation Correct/Checked: V N <br />RAD HCL / MeoH Screen <0.5 mR/hr: Y N <br />TBR <br />Temp:c Battles leceirc\ If preservation required by Login DateDate/Time <br />0_0(..V-1%_() <br />Matrix • Remarks: <br />SS - Soil AIR Air F - Filter <br />GW - Groundwater B - Bioassay <br />WW WasteWater <br />OW - Drinking Water <br />OT - Other <br />Reim hed by (Signet e) <br />Reim d by : Sig , <br />Relinquished by : (Signature) <br />Bottles arrive intact: 4 __N <br />How Other _ _ Correct bottles used: Y __N <br />Sufficient volume sent: dt N