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Billing Information: Analysis/Container/Preservative 1 Chain of Custody Pagel of� <br /> Fvlt.wm 1- <br /> Gets W. Lkies in,ei A ✓tr Chk <br /> /kcvyv'oV -A Cif Rlo1 b CL'AllBfyllCBf <br /> NNmnar CanRl lei' Np 6lnmvM on <br /> Report to'. Email To'. <br /> e^a'a't Itan" Fbvl {l-eWVi✓o .c cxvy '.tmcs to oe Q �i <br /> Mount IUTIIyh,N,T TN 3>122 <br /> IPhone. <br /> Project Description: City/State sss2se-sese <br /> Please Circle: Phone eaayeT-sass <br /> Collected: Ca/ slT KtcA PT MT CT ET Pax.ztsase sass Qa c <br /> Client Project It Lab Project It SDG IF L(3 1��Phone: <br /> dS- - 33J-SUu$ 7 -2(o'+ - KGs ler p M130 <br /> 4'YC <br /> Collected by(print): Site/Facility ID kI ' P.O.k 6 <br /> Table R S'r J<w , N� ZOZ Vc, OGSL Acctnum: <br /> Collected by(signature): Rush? (Lab MUST Be Notified) Quote M Template: <br /> //l/� _Same Day \ Five Day Prelogin: <br /> "o / _Next Day _5 Day(Bad only) Date Results Needed PM: <br /> Immediately '1A Two Day _10 Day(Bad Only) No. <br /> Packed on Ice N_ y_rFn _Three Day of J PS: <br /> Sample ID Comp/Grab Matrix- Depth Date Time ntrs Shipped Via: <br /> Penn.", sample a flab only) <br /> SB \ - SV fy ATR I O <br /> S B z - 5 6 s n7- y , p <br /> sF3 - sV G s 14 < <br /> Matrix: Remarks: Sam le Receipt Che.kl's <br /> SS-Sail AIR-Air F-Filter pH Temp Coe seal Present/Intact: iP T N <br /> GIN Groundwater B-Bioassay Cot: signed/Accurate: t�Y _N <br /> WW Waste Water Bottles arrive intact: !T _N <br /> Flow Other__ Correct bottles used: LY N <br /> DW-Drinking Water Samples returned via: Sufficient volume sent: it,Y IN <br /> OT-Other _UPS FedEz _Courier Tracking If If Applicable <br /> WA Zero HeadsPace: LY _N <br /> Reiinquish y:(Signature) Date. Time: Rec - by:(Si natu Trip Blank Received: Yes o Preservation Correct/Checked: Y _N <br /> HCL eoH RAD Screen <0.5 mR/hr: �Y _N <br /> (�(Pl7 MR <br /> Re - ed by:(Signature) Date Time: Received by:(Signs ure) Temp: °C Bottles Received: if preservation required by Login:Date/Time <br /> e 0-ill <br /> fished by:(Signature) 17 Date: Time: Received for lab by:(Signature) Date: Time: Hold: Conti idea.. <br /> '^ / NICE //O <br />