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_ Billing Information- Analysis / C • :-.ner / Preserva e Chain of Custod, Page of
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<br />Report to:
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<br />Email To:
<br />b %-_-.1,1 t L-7 Cl/G7
<br />_ :2065 Labanon Rd
<br />Mount Julrot, IN 3" .
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<br />: Collected: .:-: ,escription: sv1L- SV \ \A. c.-1=1- PT MT CT
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<br />E l I Tn.'s: S-7513-SA
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<br />800-7673 ... F.a: 61 A.
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<br />7J ole % B107
<br />Collected by (prin:/: Ste/ ity I a Ste/Facility P.O. a ce ), .
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<br />by (si r.,....(e): Rush? (Lab :40ST Be Notified) Quote a
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<br />7iamplate:
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<br />Next Day 5 Day (Rad Only) Date Res,...-.s Needed
<br />edia ely Two Day 10 Day (Bad Only,
<br />on Ice N t Y Three Day ' ----." 0 '.-, p 1.4 0 -- X .' 3:
<br />Sampie ID Comp/Grab Matrix ••
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<br />Depth I, Date Time xas 3 )° ° t— ''iriipped Via:
<br />Rornarls
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<br />] " Matrix:
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<br />.marks: al 112Ceilltt al - it Soil AM - Air i - Filter pH Temp coC seal ,...ent/intact : .:•.•,' - Groundwater is - Bioassay
<br />..)-o./ - WasteWater Flow
<br />COC Signt .,...:ourats I ' ..e.y N Bottles a : :_va intact: .."'Y --N
<br />- Drinking Water Samples ,...a: returned
<br />Other - Correct t . _.-..la a used: /J.:7 N 3 (....„ 07- Other UPS FedEx Courier Tn.; /69- ..,64
<br />Suf f icier._ vc.lume sent 1 _ _ :r Acrolicabl
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<br /> Date: Time: Rec a,: eived by: (Signature) Trip Blank Rs, Yes! o
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<br />VOA Zero -ripace I Y N
<br />Preservalt.-::: Correct/Che......,-: --Y
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<br />RAD Scree:. <0 .5 mR/hr: k-•.3z). -1_ \v1 k „...„. _MT N
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<br />Reis 17: ed b ( IF . gnature
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<br />Date: . i/ i /-Z-v
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<br />Receiveo by: (Signature) Temp: .c. Bottles Recelvo_:
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<br />If preservat.,:,.: required by Login: :...te/Time
<br />Relinquished by : (Signature) Date: Time: Received for lab by: (Signature)
<br />,22-- .+. /2"----------;.L--
<br />Date: Time: _
<br />/1/?/. 317(1)
<br />Hold: i—Conditigsti
<br />i NCF /
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