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b <br /> >y <br /> cr4 <br /> Page: of GEL Laboratories,LLC <br /> o Project#: GEL Chain of Custody and Analytical Request 2040 Savage Road <br /> O° GEL Quote#:COC Number t'1: Charleston,SC 29407 <br /> � Phone:(843)556-8171 <br /> %/� T <br /> PO Number: GEL Work Order Number: I u 7 Fax:(843)766-1178 <br /> Client Name: � '� t <br /> cr Phone#: 1 — _ ^1 Sample Analysis Requested(S) (Fill in the number of containers for each test) <br /> - <br /> Project/Site Name: 1 Fax#: <br /> Should this Preservative Type(6) <br /> GGjj� sample be et <br /> Address: i ) 1 c7 E 1 ,Vcz J�G 1 1 f`�l j considered: o <br /> 1 V ? <br /> Collected by. + t j;V�\ Send Results To: U <br /> `o Comments <br /> l a 't . o Lam'" Note: extra sample is <br /> •Time <br /> f ' required for sample <br /> *Date Collected = °P a tl p <br /> Collected QC Code Field Sample C <br /> Sample ID specific QC <br /> r mm-dd- (Military) nt Filtered tat Matrix t't ;o v i <br /> For composites-indicate start and slop dmeitime ( YY) (hhmm) F <br /> ��rira 2 13ua n1 GW l2 �G <br /> u n t 12-1 <br /> (Of i jut /tJ ti �,` lL G <br /> TAT Requested:Normal: Rush: Specify: (Subject to surcharge) Fax Results: Yes / No Circle Deliverable: C of A ! QC Summary i Level I J Level 2 / Level 3 1 Level 4 <br /> Remarks: Are there any known hazards applicable to these samples?If so,please list the hazards Sample Collection Time Zone <br /> Eastern Pacific <br /> Central Other <br /> Chain of Custody Signatures Sample Shipping and Delivery Details <br /> Relinquished By(Sign¢) Date Time Received by(signed) Date Time <br /> I1 71 �J GEL PM: <br /> �y l •, i <br /> J <br /> 9 15 Method of Shipment: Date Shipped: <br /> i/ <br /> 2 2 Airbill#: <br /> 3 13 JAirbill#: <br /> 1.)Chain of Custody Number=Client Determined <br /> For Lab Receiving Use Only <br /> 2.)QC Codes: N=Normal Sample.TB=Trip Blank,FD=Field Duplicate,EB=Equipment Blank, MS=Matrix Spike Sample,MSD=Matrix Spike Duplicate Sample,G=Grab,C=Composite <br /> 1) Field Filtered: For liquid matrices,indicate with a-Y-for yes the sample was field filtered or-N-for sample was not field filtered. Custody seal Intact? <br /> 4.)Matrix Codes:DW=Drinking Water,GW=Groundwater,SW=Surface Water,WW=Waste Water,W=Water,SO=Soil,SD--Sediment,SL=Sludge,SS=Solid Waste,O=Oil,F=Filter,P=Wipe,U=Urine,F=Fecal,N=Nasal YES NO <br /> 5.)Sample Analysis Requested: Analytical method requested(i.e.8260B,601 OB17470A)and number of containers provided for each(i_e.8260B-3,6010B17470.4 -I). Cooler Temp: <br /> 6.)Preservative Type:HA=Hydrochloric Acid,NI=Nitric Acid,SH=Sodium Hydroxide,SA=Sulfuric Acid:AA=Ascorbic Acid,FIX=Hexane,ST=Sodium Thiosulfate,If no preservative is added=leave field blank '7 C <br /> WHITE=LABORATORY YELLOW=FILE PINK=CLIENT <br />