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O M I C R O B A C- 1962 Wager Rd.,Erie, PA 16509 814.825,853315 814,825,9254 f mbe �F CUSTODY RECORD <br /> Mstrucrions on back <br /> Lab Report Address Invoice Address Turnaround Time TO SE COMPLETED BY MlCROSAC <br /> Client Name: Northstar Environmental Group, Inc Client Name: same I]Routine (5 to 7 business days) Temperature Upon Receipt eC)� � <br /> EJRt1SH (notify lab) Therm ID { <br /> Address: 417 Blythe Avenue Address: Holding lime <br /> City,State,Zip: Gallatin,TN 37066 City,State,Zip: (needed by) Samples Received on Ice?p Yes ®No p WA <br /> Contact: Rachel Meredith Contact: Report Type Custody Seals intact? n Yes p No ©N/A <br /> Telephone No.: (615)451-4867 Telephone No.: p Results Only ElLevel 1 I]Leve[2 ElLevel 3 E]Level 4 r]EDD <br /> Send Report via: n Mail i]Fax R e-mail(address) Send Invoice via: In Mail Q Fax Q e-mail(address) <br /> Project: Potrero-Fedex G Location: Tracy, Fresno,Windsor,Wat PO No.: Compliance Monitoring? p Yes ©No <br /> I]Agency/Program <br /> Sampled by(PRINT): Colby Phillips Sampler Signature: Sampler Phone No.: (615)451-4867 <br /> * Matrix Types:Soil/Solid(S),Sludge,Oil,Wipe,Drinking Water(DW),Groundwater(GW),Surface Water(SW),Waste Water(WW),Other(specify) <br /> **Preservative Types: (1)HNO3,(2)H2SO4,(3)HCI,(4)Na01-1,(5)Zinc Acetate,(6)Methanol,(7)Sodium Bisulfate,(8)Sodium Thiosulfate,(9)Hexane,(U)Unpreserved <br /> REQUESTED ANALYSIS <br /> 12 <br /> H <br /> E r W Q i <br /> v $' <br /> Date Time ° -a Preservative _ _ _ <br /> Q as : ct. . <br /> Lab ID Client Sample ID Collected Collected i <a Types * o m F- F- I- Additional Notes <br /> Fedex CA-1-2 10/05/21 12:00 2 ' S C x x x ., x x x <br /> Nan-Hazardous Radioactive Sample Dl ositlon Dispose I{{I f[f[I iI I IIII <br /> mp1 sp p pose as appropriate �Return �Archive <br /> � I I i � �1 I I JR.Ii <br /> s re) Date/Time :Received By(signature) Date/Time1� 4 6 0 / Z-� / �, ��f� r -z z <br /> Northstar Envirop�ental Group nature) Datefine eceived By(signature) Date/Time <br /> Reed:1010X2021 10:55 BY-RreWa GreWry Temp:1.4signature) Date/Time R ived By(si nature Date/Time <br /> bs <br /> rev.7116118 <br /> Page of <br />