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HomeMy WebLinkAboutNC0000272_Analytical Fecal Coliform Date per Request_20180101 (9)T �kl 4� � Li Environmental Testing Solutions, Inc. PO Box 7565, Asheville, NC 28802 Phone: (828) 350-9364, Fax: (828) 350-9368 Project Name: Project Number: Sample Identification Temperature CC) Received on Ice: Y N Sealed Cooler: Y N Samples Intact: Y N Additional Comments: CHAIN -OF -CUSTODY / Analytical Request Client Name: Address: Report to: Phone: PO Number: .6 1 1 1 1 Preservatives 0 30" o + -lot z Printed Name of Sampler: Signature of Sampler: Fax: Field pH Checked Upon C12 < 0.2 mg/1 Upon Comments 0 a, CD 0 CD G. ra 0 CD m Gn U, m a. � m •o CD 4 f I � ._ co m IQ cr r�i Cr O• � � � 0 q ..• 0 C c V roG CD o aCD o A J N � o Qo� o to O 0 O � 'TJ 'TI oa x RDCD n 0 00 00 V on w w z 0 v, to n o 00 W W 00 ^t ea��w: 0000 COD SjualutuOD PIMA uodR 0- Z-0 > uod ppajoagD I :ialdwuS jo am;euS!S :iaiduu3S 3o au►uX paunad poison r, .• aigg — :s;uammo,a leuot;ippv N / A, :IoeR soldumS M / A :ialooD palaaS AI / A :aoi uo paA►03021 (Do) am;ziadiuoL mill �11 ME MEMEMEN > 77 J C 0 C C A o Z a Q G a A CD v r a n uouuagijuapI aldmuS o � rS;)AI419Ada%)Jd a 4. :.IagiunK Od :auogd :ol jiodag :ssa IPPv :aalem;uailj jsanbaW ilu;)11"iuuV AQOZS113-LIO-NIVHD :.iagmnu ;aafoad :ameH;aafo.ad 89£6-OS£ (8Z8) :xuJ `b9£6-OS£ (8Z8) :auogd Z088Z 3K `alllAagsV `S9SL xog Od 'suoEinjos Bunsa� jeauawuolinu3 • PaceAnalytical www.pacelabs.com Section A Required Client Information: Company: ! ,-rJ y ifdreesss: ' CHAIN -OF -CUSTODY / Analytical Request Document The Chain -of -Custody is a LEGAL DOCUMENT. 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Section B Section C Page: P of F Required Project Information: Invoice Information: Report To: P Attention: ps,�� Copy To: Q 2 7 9 Company Name: Purchase Order AA Fax: Project Name: Due DatetTAT: r Project Number: Section D Matrix Codes ...► Z } Required Client Information MATRIX / CODE m a COLLECTED Preservatives Drinking Water DW O Water WT 1C. 0 Waste Water WW v COMPOSITE COMPOSITE -- Product P -a Q START END/GRAB w Soil/Solid SL SAMPLE ID oil OL KO (A-Z, 0-9 / ,-) Airpe AR W v a ¢ Z y Sample IDs MUST BE UNIQUE Tissue TS p a g Q o H _ Other OT U w z 3k X J a-ro Lu O dZi o In Lu ~ 2 O a O O O L N DATE TIME DATE TIME W � 2 2 2 Z a L 0 Q y tw 3 r 4 a: /i ` t./gut, VJ N7' 1 v9 'LJ -41 - - t — tip ADDITIONAL COMMENTS RELINQUISHED BY / AFFILIATION A DATE TIME 9 £'%9'( REGULATORY AGENCY F1 NPDES F GROUND WATER ( DRINKING WATER f UST F RCRA OTHER Site Location STATE: Requested Analysis Filtered (Y/N) ACCEPTED BY t AFFILIATION SAMPLER NAME AND SIGNATURE PRINT Name of SAMPLER: r SIGNATURE of SAMPLER: ! ri DATE /?r;, �..3 (MM/1 "Important Note: By signing this forth you are accepting Pace's NET 30 day payment terms and agreeing to late charges of 1.5 % per month for any invoices not paid within 30 days. fS DATE Y TIME Z C o` U ml rn Pace No./ Lab I.D. 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Address j ( Copy To f to Email To: Purchase Order No.: ,,, C V /` Phone: Fax: Project Name: Requestedbue Date/TAT: Project Number: Section D Matrix Codes Required Client Information MATRIX / CODE m a Drinking Water DW ; 00 Water WT Lj Waste Water WW v COMP Product P Q STA Soil/Solid SL C7 SAMPLE ID Oil OL (A-Z, 0-9 / ,) Airpe AR w Sample IDs MUST BE UNIQUE Tissue TS p a- Other OT U xt X w w Q a _ a DATE 3 4 %a 6 !: r M.� ADDITIONAL COMMENTS RELINQUISHED BY IN `Important Note: By signing this form you are accepting Pace's NET 30 day payment terms CHAIN -OF -CUSTODY / Analytical Request Document The Chain -of -Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. PaceAnalytical W".Pacetabs.corc Section A Required Client Information: d AAroee• � • _ � Section B Required Project Information: Copy To: W Cak*A) k)O 23`71C0 I To: Purchase Ordi Project Name: Tested Due DaterTAT: (Df lD L ii.7 Project Numb; s CHAIN -OF -CUSTODY / Analytical Request Document The Chain -of -Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. Section C Page: of Invoice Information: ection D Matrix Codes Required Giern inrormation MATRIX/CODE e COLLECTED Drinking Water OW Water WT R O V . p Waste Water WW P i7 = m COMPOSITE STAnT COMPOSITE ENo�crwt F- Soil/Solid SL SAMPLE ID Oil " ° CO vOLL (A-Z, 0-9 / ,-) Air AR W v ¢ W 2 Sample IDs MUST BE UNIQUETissue TS p 0.. E H tk Other OT U X j ~ O n. n. F- Q 0 a 4 U O N DATE TIME DATE TIME N a 1 s 9 ADDITIONAL COMMENTS RELINQUISHED BYlAFFILIATION DATE TIME 2 92795 flame: REGULATORY AGENCY NPDES GROUNDWATER DRINKING WATER UST RCRA OTHER Site Location STATE: Requested Analysis Filtered (YIN) 2 Preservatives i ACCEPTED BY I AFFILIATION z m O t U �° a 35-7 S -6 m ace Project No./ Lab LD. DATE TIME MPLE CONDITIONS c/ If 1� .R /i ri O SAMPLER NAME AND SIGNATURE :ysG!P:ir�t � m PRINT Name of SAMPLER: t r0 E m o ci Z 9 Z r Y Ci a E U y SIGNATURE of SE AMPLER- DATE Signed F (X c� E iMM1D01Y1'): rq 'Important Note: By spnio I [his form you are accepting Pace's NET 30 day payment terms and agreeing to late charges of t_5% per month for any Invoices not paid within 30 days. F-ALL-Q-02 rev.07, 15-May-2007 04,10 CHAIN -OF -CUSTODY / Analytical Request Document FaeeAnalytleal The Chain -of -Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. N www.pacelahs.com 0 to Section A Required Client Information: Z6'80 Due Date/TAT: Section B Required Project Information: Report To: bTo: Copy 1 Purchase Order No.. r/ --24i3 Project Name: d Ser:tion C Invoice Information: of i tEGULATORY AGENCY NPDES F GROUND WATER DRINKING WATER r UST I' RCRA OTHER Site Locat(on STATE: nalysis Filtered (Y`1 at f ~ Section D Matrix Codes Requlrod Client Information MATRIX t CODE Drinking Water OW Water WT Waste Water WW Product P SoiUSolid SL SAMPLE ID w e wL (A-Z, 0-9 ,-) Airp AR Sample IDS MUST BE UNIQUE Tissue TS Other OT — °c—' s Is ��., w p 0 U X Q. 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DATE I TIME I SAMPLE CONDITIONS U _ d o c v z r o 5 n >i 8oz �z E to m w> aT F U to E N M F-ALL-0-020rev.07, 15-May-2007 r PwMnalytical www.Paeelabs.com Section A Required Client Information: Company:j Addresser 4fh 1;4 nt) DatefrAT: CHAIN -OF -CUSTODY If Analytical Request Document The Chain -of -Custody is a LEGAL DOCUMENT. All relevant fields must he completed accurately. Section B Required Project Information: Section C Invoice Information: No.: Section D Matrix Codes Required Client Information MATRIX /CODE u — a M COLLECTED z Drinking Water DW E p c) Preservatives j Water WT U Z o Waste Water WW COMPOSITE COMPOSITE H Product P ST—T ENU(;W.n W Soil/Solid SL 9 -' SAMPLE ID a! QL 0 o rn ..► v X (A-Z, 0.9 ! ;) Air AR w ¢ w Z Sample IDS MUST BE UNIQUE Tissue TS O n. a ¢ a m t— Other OT L) 0. w t- E- Z m Z N w X w J 0. W m O C ¢ ¢ M w0 na. 0O O� 4= C rn TIME DATE TIME In u j= _= Z Z 2 0 Qif I'VDATE U A Page: of REGULATORY AGENCY NPDES 7 GROUND WATER DRINKING WATER UST — RCRA OTHER Site Location /♦ STATE: � `-' t/' Requested Analysis Filtered (Y/N) r :} z: J - Z0 Z V ww & ADDITIONAL COMMENTS RELINQUISHED BY / AFFILIATION :41 DATE TIME ACCEPTED BY I AFFILIATION DATE TIME ORIGINAL SAMPLER NAME AND SIGNATURE PRINT Name of SAMPLER: /- SIGNATURE of SAMPLER: 'Important Note: By signing this form you are accepting Pace's NET 30 day payment terms and agreeing to late charges of 1.5 % Per month for any invoices not paid within 30 days. Z t Pace Project NoJ Lab I.D. SAMPLE CONDITIONS U c m V 0 9 c a 2 c Z H = U E y F-ALL-Q-020rev-07, 15-May-2007