|
Billing Information: Analysis, Container/Preservative Chain of Custody Page of ,
<br />Pres
<br />. 0,tlikii.- Chk
<br />co Analytical'
<br />'3.. ,1
<br />Report to: Email To: 12065 Lebanon Rd CI 0
<br />-D .
<br />mount Juliet, TN 37122 ' •-•"‘ l 'it- c 1> >4-1 ,iti-‘ ee,,...- E .i •J k t -Um., vo,Ge....3Y', •--•4- e ..1 Phone: 615-758-5858 .
<br />Phone: BOO-767-583,i Project Description: City/State siTit,.0,-ir..,--, , ,-.1.- Please Circle: Fay, 613•758-5859 0
<br />V Collected: PT MT CT ET --1-7Z----- 57 jii.-\._ •>" 0,4-, .1...a.-...,....,..,,, .
<br />Client Project 4 Lab Project C SDG ti 13c-i 5
<br />Ph one:
<br />331
<br />.-----N
<br />9 )v
<br />
<br />C168 , -)--q- 15-4 ----, 1 1 - 7..,• „p m s ..• 0 il.l• 4.-•. ..., C ..._, ../1 T
<br />Collected by (print): Site/Facility ID St P.O ft )
<br />
<br />. _
<br />LI' -T I i .
<br />
<br />3 Acctnum: -.1._ \ . ov.,,, ..,,..s- ..,,
<br />5 Collected by (signature): Rush? (tab MUST Be Notified) Quote St
<br />/
<br />0- Template:
<br />Satre Day / rive Day Prelogin:
<br />Next Day 5 Day (Rad Only) Date Results Needed 0' P pm: \ 3--1'C) I Imm ely Two Oat 10 Day lead Only) No. - . I
<br />Packed on Ice N "` Y Three Day of J PB:
<br />i I
<br />Cntrs i '7' 0 Shipped Via:
<br />Sam Comp/Grab Matrix Sample ID Date Time 0 ,/, 7 ' Depth
<br />
<br />PemarKs Sarrme # (143 only)
<br />I Coo-t-r-, i
<br />—11
<br />56.- •,... - Ak -._ 6P-4- r5 ,ts. 1 -0,11,11 I .../ 6 . 7 Ls.,
<br />- 0.- —T s-c-- Li% •--,
<br /> -
<br /> _
<br />-
<br />Matrix: Rernarks: Samo-e Receivt Checklist/
<br />SS - Soil AIR - Air F- Filter pH
<br />74
<br />
<br />Temp COC Seal Present/Intact: NP Y N
<br />
<br />: . GW - Groundwater 8 - Bioassay COC Signed/Accurate —N
<br />Bottles arrive intact: rof — N
<br />WW - WasteWater Flow Other Correct bottles used:
<br />_
<br />v./Y N
<br />DW - Drinking Water Samples returned via: Sufficient volume sent: .'? —N
<br />OT - Other UPS _ FedEx _ Courier Tracking ft —7-7 44,1.il Le) -,5 (s, otco oili
<br /> VOA Zero HeadsIfpaALP:licable Y N
<br />Relinquished by: (Signature) Date! Time! Received by! (Signature) Trip Blank Received: Yes/ No Preservation Correct/Checked: Y N
<br />./-.) HCL / MeoH BAD Screen <0.5 mR/hr: vill_N I /
<br />--'(,—tol /Z -:---- -I- i [ T3R
<br />OS Relin ish d yiS a re) Date: Time: Received by: (Signature) Temp: A01 ,I
<br />
<br /> Bottles Received: If preservation required by Login: Date/Time
<br />t
<br />-4"---r---'—w— r 1 4-1 S-Z, 4144.1:q.CI 4—
<br />Relinquished by: (Signatu e) Date: Time: R ceived for lab by: (Signature) Date! Time: Hold: 1 c NCoFrid iitioo
<br />81 .e-Ia-i clis
|