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Company Name/Address: Billing Information: Analvcic/fnntainpr/Prpc rn/Ativp Chain of Custody Page_of_ <br /> Trileaf- AZ Attn: Marcia Weger Pres <br /> 10845 Olive Blvd.,Ste.260 chk <br /> ace <br /> Cha West Chandler Blvd,Ste 203 Saint Louis, MO 63141 FEUptr ADVANCING SCIENCE <br /> Chandler,AZ 85224 <br /> Report to: Email To:c.schaumburg@trileaf.com MT JULIET,TN <br /> Connor Schaumburg1206S Lebanon Rd Mountlu6et,TN 37122 <br /> 5ubmittmg a sample via this chain of custody <br /> constitutes acknowledgment and acceptance of the <br /> Project Description: City/State Please Circle: pace Terms and conditions found at: <br /> Alpine&Sanford Collected: ti C P MT CT ET L https:/Iinfo.pacelabscom/hubfs/pas-standard <br /> ,— s_ > terms.pdf <br /> Client Project# Lab Project# ) p <br /> Phone:480-850-7850 SDG# <br /> 731278 TRILEAFAZ-731278 E <br /> _— V1 0 037 Q <br /> Collected by(print): Site/Facility ID# P.O.# <br /> a <br /> i n ��h © Acctnum:TRILEAFAZ <br /> t1lorflected by(signature): J Rush? (Lab MUST Be Notified) Quote# CL <br /> O Template:T259380 <br /> Same Day _Five Day a Z+ <br /> Prelosin:P1097975 <br /> Next Day 5 Day(Rad Only) Date Results Needed a* (J Q <br /> Immediately Two Day 10 Day(Rad Only) PJo O rd PM:288-Daphne Richards <br /> Packed on Ice IN Y Three Day of Ce (D � O PB: <br /> Shipped via:FedEX Ground <br /> Sample ID Comp/Grab Matrix* Depth Date Time ntrs O O CJ <br /> 5 O t Remarks Sample a(lab only( <br /> Q l7 CL a t <br /> SS <br /> *Matrix: Remarks: Sample Receipt Checklist <br /> SS-Soil AIR-Air F-Filter pH Temp COC Seal Present/Intact: _ P _YN <br /> GW-Groundwater B-Bioassay COC Signed/Accurate: _✓7 N <br /> Flow Other Bottles arrive intact: _N <br /> WW-Wastewater Correct bottles used: -- <br /> N <br /> Samples returned via: <br /> DW-Drinking Water Sufficient volume sent: ✓Y N <br /> — <br /> OT-Other —UPS _FeclEx —Courier Tracking# '7 If Applicable <br /> i.� VOA Zero Headspace: Y N <br /> — — — �" - - - �erva C>.on-Correct Checked. Y N <br /> gtnstle y:f rrJiure) Date. Time: ceived by:(Signature) Trip 81ank Received: Yes/ RAD Screen <0.5 mR/hr: yY N <br /> HCL/MeoH <br /> 's TBR <br /> ;�inqui y:(Si e) Dat Time: Received by:(Signature) Temp: +�o Bottles Received: If preservation required by Login:Date/Time <br /> Relinquished by:(Signature) Date: Time: Received or b by:(Signature) Date: Time: Hold: Condition <br /> tI�'C_ -ter 9 S ,\ NCF /L%' <br />