2012-06-27_INSPECTION - M1980244

• Permit No: M1980244
• IBM Index Class Name: INSPECTION
• Doc Date: 6/27/2012
• Doc Name: INSPECTION REPORT
• From: DRMS
• To: CC&V
• Inspection Date: 5/9/2012
• Email Name: TC1
• Media Type: D
• Archive: No

ANALYTICA
GROUP
Version 2.0
12189 Pennsylvania St
Thornton, CO 80241
(303)489 -8888
(303) 4696254 fax
Analytica Chain of Custody Form
4307 Arctic Boulevard
Anchorage, AK 99503
[phone]
[phone] fax
475 Hall St
Fairbanks, AK 99701
(907) 456 - 3116
(907) 456 -3125 Fax
5438 Shaune Drive
Juneau, AK 99801
[phone]
[phone] fax
Page of
Chain of Custody No: 81241
Client Name & Address:
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Phone No: ( 30 3 _ - 35& x 9( 6
Fax No:
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E -mail: 'ii i.+, „x,a • ,f 5 +1C. (,Q . /4S
Kit Prep/Shipping Charge: $
Client Sample Identification / Location
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Name of Sampler: (printed)
Date
Date
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Time
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Time
Time
Public Water System (PWS) ID#:
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Requested Due Date for Results:
Date
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Time
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Re• -ived by
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Turnaround Time for Results (TAT)
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Received b :
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Date
Date
Date
Time
Time
Time
Quote ID:
Account #:
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Invoice to Name & Address:
P.O. or Contract No:
Requested Analysis /Method
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Condition of
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Thermo ID #:
Shipped Via:
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