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Home My WebLink AboutDEQ-CFW_00071330Tes-tAmen'ca Shipping Order Form - Bottle Order THE LEADER IN ENVIRONMENTAL TESTING Shipping Order ID: 65747 Ship To Information Project Manager: Michelle Johnston Company Name: NC-DWR Attention: Attn: Jim Gregson Address 1: 127 Cardinal Drive Extension Address 2: Address 3: City: City: Wilmington State: NC Zip: 28405 Phone #: 252-671-4778 Project Ref: FAY-NC-DWR HFPO-DA SAMP Notes to Bottie/Shipping Department Please include cooler, cooler liner, custody seals, pre-printed labels, pre-printed chains of custody, pre-printed FedEx return labels for TA Denver, DI water and temperature blanks. Please use plastic, non-teflon lined bottles for DI water. Please relinquish the COCs and affix the container labels. Please label cooler "FAY - NC-DWR HFPO-DA SAMPLING" !�2 8ui0�WniH57�4m7NlVl Ship Via: FedEx Ground 0 Ready to Fill Q Seals on Coolers []Seals on Bottle ❑ Bottle Sets ❑ Ice Cooler TestAmerica Denver 4955 Yarrow Street Arvada, CO 80002 Phone (303) 736-0100 Fax (303) 431-7171 Due On: 7/5/2017 12:00:OOPM Q Labels with Bottles El Preprinted Q Labels on Bottles Q Preprinted COC ❑ Rebill Freight Q Return Shipment Labels Number of Return Shipment Labels (Prepaid Return) Please notify us immediately if an error is found in shipment Shipping Order ID: 65747 Page 1 of 3 Printed on 6/28/201710:37:20AM Shipping Assets 0 m p C� m I 0 0 0 w w Assets I Quantity Description Filled Blank labels 1 pre-printed, please affix ❑ COCs 3 pre-printed, please relinquish ❑ Cooler liners 1 per cooler ❑ Coolers 1 as needed ❑ Custody Seals 2 per cooler ❑ DI Water 2 x1 L bottles ❑ Pre -label Bottles 1 please ❑ Pre-printed FedEx Labels 1 pre-printed for TA DENVER ❑ Temperature Blanks 1 per cooler ❑ Shipping Order ID: 65747 Please notify us immediately if an error is found in shipment Page 2 of 3 Printed on 6/28/201710:37:20AM Bottle Order Information Order Completion Information 0 m p C7 J I O O O w w N Bottle Order: FAY-NC-DWR HFPO-DA SAMP Bottle Order #: 22336 Request From Client: 612812017 Date Order Posted: 612812017 10:14:57AM Order Status: Ready To Process Prepared By: Dylan Bieniulis Deliver By Date: 71512017 12:00:OOPM Lab Project Number: 28016914 Creator: Dylan Bieniulis Filled by: Sent Date: Sent Via: Tracking #: Sets Bottles/Set Qty Bottle Type Description Preservative Method Matrix Sample Type Comments Lot # 14 2 28 1 Plastic 250ml - unpreserved None I L Water Normal HFPO-DA Notes to Field Staff: Health and Safety Notes: Preservative Comment Relinquished By Company Date Time Received By Company Seal #: Seal #: Seal #: Seal #: Relinquished By Company Date Time Received By Company Seal #. Seal ik Shipping Order ID: 65747 Please notify us immediately if an error is found in shipment Page 3 of 3 Printed on 6/28/201710:37:20AM r Approved Lot Numbers for Sample Bottles and Preservatives TAma 6/27/2017 ESS r,+c,unrnP.+e-: ROMP.Mr.k.Morm,, Cor+taine Type 50 Lot* Preservatrve_ 1 Gallon Amber 4000-0250-QC 0103101C Unpreserved NA 1 GallonCubitaner37851D30-QC -. 0320609Y Unpreserved 1 L Amber 1000-0150-QC 0104101B/0108201C Hydrochloric Acid 56134/56293 1_14erAmbi r 7000 Q10 ClC =" 01041018 SodiumThio'sulfate - WO8$6/OOt30D48 1 Liter Amber 1000-0150-QC 0108201 C Sulfuric Acid 0000161554 1 Liter Poly 1000-1901-QC 0206901C Nitric Acid 0000162027/0000042514 1,Lite Poly =1000-1901;0c.. - - 0128961YJ010J7D1C Sli +ric P,oid - s77_' DOOD056441/QQ0016I554 r 1 Liter poly 1000-1901-QC 0206901 C Upreserved -0 040A `Un `NA ed NA125mLAerQ021 125 mL Plastic 0125-1060-QC 0418201Y Upreserved NA -77777 15m1 L-`DPE drt)Pper - QEC " 041017-H2SO4` . $yffunc'J1cid " •' 777777777 149i!88 15ml LDPE dropper - QEC 051016-HCU041017-HCL Hydrochloric Acid 132880/162118 15m1'LDPE dropper= QEG biso,+ona±rosa,tsimao NiMc Acid :• _ ,33393%16202ffil04117 16 oz Jar 0500-0015-QC 0110101Y Unpreserved NA IF&IFW17, 0500-100Z3 : 0202501Y Unpr�s ved NA , ..__, . , 2 oz Jar 0060-0015-QC 0410101 Y Unpreserved NA 250rriLAriibe W&65 0150-QC ti40O501A/0308201n 1Na 30(i5r_ ._ 250 mL Amber 0250 0150-QC 04010501A/0308201C Sulfuric Acid 0000161554 mA02-0750QC 1 YrerXed250 . _, . _ 250 mL Poly NA NOT IN USE Sodium Hydroxide NA 250 mL Poly 0250-i 901 (ACC. " 0313901 B - - Sutfurio Aoid f . '. 0000137221 ' ; _; 250 mL Poly 0250-1901-QC 0406901 C Unpreserved NA 250t j I?olyD 50 i$01 tlC< 0406901n OOOD08$7O 00001�4982. c 250�riLPolyQ250 1901-(3C . ' 9U1C : t�rtr3cA�ctd� ,. 'a0001 32 oz Jar 0950-0010-QC 0316901 B Unpreserved NA 4 oz Jar 01250*55iC 026001 B, - %• = Ur1P s$(vd :. NA - ` °' 40 mL VOA 40AA-0300-QC 0213801 B Ascorbic Acid K39581 40 :mG VQA 4020.5035-QC 01229015 iDI Vvaf@r =„ NA 40 mL VOA 4025-300-QC 0219601 B Hydrochloric Acid 56134/56293 40 mL VOA 9000035 QC 0322901B Aheihahol; . [)C258S ' 40 mL VOA 4049-5035-QC 0327101X Sodium Bisulfate 143424 40 mL VOA 0046-3004C 02138018 ' Sodium Thio$ulfate 66"152?27 40 mL VOA 0040-300-QC 0213801 B/013213801 B Unpreserved NA 60;rYiL_VflA,7260=U410 G1C 052260INO f�:9.:_260537t Unpiesen eC! .. NA 40 mL VOA 0040-0410-QC 0119601E Unpreserved Amber NA C Am 0500 0150 0C 020S201C S ffuric Acid 6000161554 500 mL Amber 0500-0150-QC 0405901 Y/0208201 C Unpreserved NA 506 mL Poly 0500-1901-QC 020s2otcr0sW4D!C'/M201C Nitric Acid ` ' 00001620227/0000042514 500 mL Poly 0500-1901-QC 0306901 C Unpreserved NA 60 mL VOA 7260-0410-QC 0622601BI0522661A _ Monochloroacetic Acid 304028/703005-- 8 oz Jar 0250-0055-QC 0226001 B/012801 C Unpreserved NA S oz Poly Jar.6250-1041-QC 0234301z Unpreserved NA En Core Sampler (En Novative) 14281 NA NA $terIIe `125 mL Plastic (FISHER) 0009/0018 NA NA Sterile 20 mL Syringe (FISHER) 6354862/6217791 NA NA Sterile'60 mL Syringe (Fisher) 6327654 NA NA Syringe filter, 0.2um Sterile (FISHER) 14616044/24616060 NA NA Syringe Filter, 0.45um (MG Scientific) 7006441` NA NA 125ML 0125-2052-sp 1193422 NA Trip Blank 4025-0300-QC By DateHydrochloric Acid By pate Trip Blank 0040-0300-QC By Date Sodium Thiosulfate By Date Trip Blank 0640-0300-QC By Date Unpreserved By Date_ 4oz Jar A-mber.(Qec) G-7-067-41)6 7 Unpreserved - NA 500ml Poly Amber 0500-1270-QC 0218201Y Unpreserved NA 250MI Poly Amber0250-1270-QC 0318201Y Sodium Hydroxide;- 134482 DF-F-0057-3-1 7-2017 Rev 0 G:\Login\Bottle Prep\Lot Numbers\ Page 1 of 1 Bottle Prep Lot Numbers List_6-27-17 DEQ-CFW 00071333