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Page: I of GEL Laboratories,LLC <br /> Project#: GEL Chain of Custody and Analytical Request 2040 Savage Road <br /> GEL Quote#: t l a 1 <br /> Charleston,SC 29407 <br /> COC Number('): Phone:(843)556-8171 <br /> GEL Work Order Number: / <br /> PO Number. t (� Fax:(843)766-1178 <br /> Client Name: ,_, Phone#: ts> <br /> r ' ` l{ S (vl v LZL1 Sample An <br /> Requested (Fill in the number of containers for each test) <br /> Project/Site Name: �; �` Fax#: Should this <-_Preservative Type(6) <br /> n {1 sample be 'mm <br /> \�., <br /> Address: (V- 1a` tC�1 _vx.r �s�l considered <br /> ` -' r-JComments <br /> Collected by: ' ` 1� Send Results To: �`,,v� L 1 <br /> L\��° v , ? _ Note:extra sample is <br /> i r s <br /> *Date Collected <br /> 'T'me = ; `_ r ? ,t �i- required for sample <br /> Sample ID Coll-ted QC Code Field Sample <br /> ('1Ln=.aryl of Filtered ui Matrix i4t '- < specific QC <br /> •For composites-indicate start and stop Mute time (mm-dd-yy) hhmm) C F F i h 2. r J S► rJ <br /> All sc rr: I Luc <br /> , i <br /> nJ J w �v t. ;� v ✓ ;� ;� ✓ r ,i i ofi,l t b .rl, ctin <br /> I <br /> TAT Requested:Normal: Rush: Specify: (Subject to Surcharge) Fax Results: Yes / No Circle Deliverable: C of A / QC Summary / Level I / Level 2 / Le el 3 / Level 4 <br /> Remarks: Are there any known hazards applicable to these samples?If so,please list the hazards Sample Collection Time one <br /> Eastern Pacific <br /> Central Other <br /> ountain <br /> Chain of Custody Signatures Sample Shipping and Delivery Details <br /> Relinquished By(Signed) Date Time Received by(signed) Date I r.te <br /> t /� r GEL PM: <br /> 1 "� u-ZS-f 3 l3GiC> , q-a J J� Method of Shipment: Date Shipp ed: <br /> 2 2 Airbill#: <br /> 3 13 Airbill;l: <br /> L).Chain of Custody Number=Client Determined <br /> 2. 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 For Lab Receiving Use Only <br /> 3.)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 Seat 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,60I0B/7470A)and number of containers provided for each(i.e.8260B-3,601OB17470A -1). Cooler Temp: <br /> 6.) Preservative Type:HA=Hydrochloric Acid.NI=Nitric Acid,SH=Sodium Hydroxide,SA=Sulfuric Acid,.AA=Ascorbic Acid,HX=Hexane,ST=Sodium Thiosulfate,1 f no pres_r._.::.a is added=leave field blank C <br /> Page 4 of 99 WHITE=LABORATORY YELLOW=FILE PINK= -:'oT <br />