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Gating Services Dallas 1489 East Colli Richardson,TX 75081 (214)238-5591 CHAIN OF CUSTODY ORD <br /> Report to Invoice to ANALYSIS Lab use <br /> arrTy <br /> Company Company REQUESTED Due Date <br /> Address Address <br /> 0 Temp of coolers <br /> when received(C°) <br /> Contact C' IJ Contact } , 2 3 4 s <br /> Phone Phone ' <br /> Fax POISO# 0 Custody Seal N/Y <br /> Intact N/Y <br /> SamSamplers Sa IersSi Signature Screened <br /> p � For Radioactivity <br /> Prof No Project Name No/Type of Containers <br /> c- , r <br /> c G <br /> Mainz' Date Time ° r Identifying Marks of Samples VOA A1G 250 P10 <br /> m a 1 u ml Lab Sample ID(Lab Use Only) <br /> p b <br /> l./3 <br /> C <br /> goc <br /> Q _ z�, C G c) <br /> CAi <br /> v,:�S <br /> S ` A,ch cy <br /> oci-1is t ly/ C Jt <br /> Turn around time ❑Priority 1 or Standard Q Priority 2 or 50% ❑Priority 3 or 100% ❑Priority 4 ERS+ +BTEX(60218020) TPH 1418 1 or 8015) VOLATILES(62418240) IGNITABILITY TOTAL LEAD(6010) <br /> 71quisbed {Signature) Date Time eceived by (Signature) Date Time Remarks <br /> Relinquished by (Signature) Date Tim Keeived by gnature) Date Time <br /> i <br /> Relinquished by (Signature) Date Time Received by (Signature) Date Time Client s delivery of samples constitutes acceptance of Inchcape/ITS Dallas terms <br /> and conditions contained in the Price Schedule <br /> i <br /> Matrix WW Wastewater W Water S Soil SD Solid L liquid A Air Bag C Charcoal tube SL Sludge O Oil ITS-Dallas cannot accept verbal changes <br /> ' Container VOA 40 ml vial. AIG Amber 1 Or Glass 1 Liter 250 ml-Glass wide mouth P/O Plastic or other Please Fax written changes to <br /> 214-238-5592 <br /> OFFICE USE ONLY <br />