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Billing Information: Analysis/Container/Preservative 1 Chain of Custody Page L of� <br /> FvlLwm Pres <br /> [��� W• L�'LKS�nr1 A ✓tr Chk l <br /> µwyrpvI-A CIt VOj b NN1-1seAna a � <br /> r Can!e'k!'-os Ng ALmynm <br /> Report to Email To'. <br /> pN,SY Itar" FbvWte fl-LNV/✓b .c cvvy tmcs amm <br /> Mount IIMo Tn TN IU 3)122 <br /> Crone. <br /> Project Description: City/State b15)se-sese <br /> Please Circle: Pnonr.eaa)s)-sass <br /> Collected: Celli SfT><KtT'Y` PT MT CT ET Far.ztsasesass Qa c <br /> Client Project# Lab Project# SDG# Ll 3 I R�Phone: <br /> ds' - 20-2 - KGs Le I M130 <br /> O <br /> Collected by(print): Site/Facility ID#I ' P.O.# 6 <br /> Table# <br /> Uv-LS'C I�Gl^ N 'L OZ VO}- 0 G S L Acctnum: <br /> Collected by(sigpature): Rush? (Lab MUST Be Notified) Quote# Template: <br /> _Same Day r Flve Day Prelogin: �i <br /> _Next Day _5 Day(Bad only) Date Results Needed PM: <br /> A Immediately V Two Day _10 Day(Bad Only) No. <br /> Packed on Ice N_ y_rrx _Three Day of J PB: <br /> Sample ID Comp/Grab Matrix- Depth Date Time ntrs Shipped Via: <br /> aem,ortis saTPiealae omy) <br /> sF3 14 x <br /> n Matrix: Remarks: Sam le Receipt Che.kl'sc <br /> SS-Sail AIR-Air F-Filter pH Temp Coe seal Present/lneact: iP _x N <br /> GW Groundwater B-Bioassay Coe Signed/Accurate: t,.Y _N <br /> WW Waste Water Bottles arrive intact: !Y _N <br /> Flaw Other _ Correct bottles used: LY N <br /> DW-Drinking Water Samples returned via: Sufficient volume sent: yY _N <br /> OT-Other _UPS Fell _Courier Tracking If 1f Aoolicabla <br /> WA Zero Headspace: LY _N <br /> Relinquish y:(Signature) Date. Time: Rec - by:IS nato Trip Blank Received: Yes o Preservation Correct/Checked: x _N <br /> HCL eoH RAD Screen <0.5 mR/hr: Y _N <br /> MR <br /> Re i - ed by:(Signature) Date: Time: Received by:(Signs ure) Temp: oC Bottles Received: if preservation required by Login:Date/Time <br /> e kf e 2/ <br /> Walineddiished by:(Signature) Date: Time: Received for lab by:(Signature) Date: Time: Hold: Condi ' <br /> '^ / NICE /F O <br />