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Page: ' of GEL Laboratories,LLC <br /> Project#: GEL Chain of Custody and Analytical, Request 2040 Savage Road <br /> GEL Quote#: Charleston,SC 29407 <br /> COC Number t 1: �J f /%/ Phone:(843)556-8171 <br /> GEL Work Order Number: �' �{'(� Fax:(843)766-1178 <br /> PO Number. I <br /> Client Name: �Lt— Phone#:y 675 2.2,Zi Sample Analysis Requested(5) (Fill in the number of containers for each test) <br /> Project/Site Name: Su� LjcA j t a 20i j Fax Should this ; < Preservative Type(6) <br /> `n sample be <br /> Address: 6 L4 25 S- l�: i`{i T5 I v, T considered: c tV <br /> d c <br /> Collected b Send Results To: y ry ° a C d ' a 1 Comments <br /> y Ciayf /V1�3� Ko-4i.Y l,.�e n-e. d S d 406 <br /> S Note:extra Sample is <br /> CD 4.'Date Collected .Time = '� ; ' j2 a required for sample <br /> Sample ID Collected QC Code Field Sample Y a I d /� N Q <br /> specific C <br /> (Military) tzt Filtered ut Matrix t't ° < i <br /> 'For composites-indicate start and stop date/time (mm-dd-yy) (hhmm) <br /> '� i � l pity tviv FD Y lr io x n <br /> M i,J 2 !I i � A/ LA) IO X X 7c <br /> 't3 twtia l J 31 i C- t:1 /V lO <br /> I <br /> I <br /> TAT Requested:Normal: Rush: Specify: (Susie<, ,­harge) Fax Results: Yes No Circle Deliverable: C ofA / QC Summary / Level I / Level 2 / eel 3 i 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 /> ai�3ourtain Z. <br /> Chain of Custody Signatures Sample Shipping and Delivery a7etails <br /> Relinquished By(Signed) Date Time Received by(signed) Date Time <br /> GEL PM: <br /> "' Method of Shipment Date Shipped: <br /> _ rd <br /> 2 { I 3 1�( OCi 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 /> 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. i 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,60106/7470A)and number of containers provided for each(i.e.8260E-3,60JOB17470A -1). C'ook%Temp. <br /> 6.)Preservative Type:HA=Hydrochloric Acid,NI=Nitric Acid,SH=Sodium Hydroxide,SA=Sulfuric Acid,AA=Ascorbic Acid.HX=Hexane,ST=Sodium ThiosL!ia-.._, ,. ,........c's added=leave field blank q C <br /> WHITE=LABORATORY YELLOW=FILE <br /> Page 4 of 94 <br />