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Billing Information: I I Anai sis/Container/Preservative Chain of Custody Page_of <br /> `vA Pres <br /> __ aceAlralytiCal' <br /> Report two: Email To: V1/L G <br /> JC'q \Z c�,� I 12065 l.banon Rd � Q <br /> Project C-�•5� J M �� ` �V\� I Phonet:615,758-esaz M <br /> City/State5T'VLy�T�ti Please Circle: Phon.:sop-767-s8s9 byDescription: , Collected: L 4 PT MT CT ET Fax:615.758-5859 <br /> ��-i Client Project If Lab Project iY <br /> Phone: 9�b 3y 1 <br /> 0 <br /> Fax: 1 1 2 J 0 <br /> - 0 4 s 1 . -L--4t Jy '-1 96 r D052 <br /> Collected by(print)- Site/Facility ID p P.O.is F- <br /> �,{ W n <br /> (�Y� �T hG�� ---- —�l•-'E 00 -41 — -- J I Acctnum: La-1 <br /> Collected b (signature): RushT (Lab MUST Be Notified) Quote p D � Template: <br /> Same Day X Five Day _ r Prebgin: <br /> _Next Day _S Day(Rad Only) Date Results Needed ' <br /> Immediately _Two Day _10 Day(Rae Only) No PM: <br /> N <br /> Packed on Ice _ Y _ Three Day <br /> of PB: <br /> Sample ID Comp/Grab Matrix' Depth Date Time ntrs ~ Shipped Via: <br /> v� <br /> - --_ - _ Remarks Sample a(lab onM) <br /> Z.7 �`bLO$p LSM 1O�t'� -ta VD� I O <br /> i <br /> i <br /> i <br /> I <br /> ' ----------- <br /> Matrix: ---— - <br /> emarks: _17+7 <br /> 55-Soil AIR-Air F-Filter Sample Receipt checklist,✓ <br /> pH Temp COC Seal Present/Intact: NP y Y N <br /> GW•Groundwater B-Bioassay COC signed/Accurate: _ �y —N <br /> WW Wastewater Bottles arrive intact: y —N <br /> DW-DrinkingWater Fb+v Other Correct bottles used: �y <br /> Samples returned via: ______ h N <br /> OT-Other -- __ Sutficient volume sent: N <br /> _UPS —FedEx _Courier _ Tracking>Z If Applicable <br /> VOA Zero Headapace: y N <br /> e inquish by gnature) Date: Time: r� Refired bb :(Signature) Trip Blank Received: Yes/No Preservation Correct/checked: _y N <br /> 10 "\^? '�� l ` a"" '/„ HCL/MeoH MAD Screen <0.5 mR/hr: <br /> Relin ished by:(Signatur Date TBR <br /> Time: R eived by:(Signature) Bottles Receh <br /> I Temp: 'G If preservation required by Login:Date/Time <br /> Relinquished by:(Signature) Date: Time: I Received for lab nature) Date: Time: {� Hold: -F Conditi� <br /> NCF / \..7 <br />