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Analytical & Consulting Chemists
ENVIRONMENTAL CHEMISTSINC Windmill 2-0 15
1 oF,-93FAX[phone]
NCDENR: DWQ CERTIFICATION # 94 NCDHHS: DLS CERTIFICATION # 37729 [e-mail]
COLLECTION AND CHAIN OF CUSTODY
Client: , (` W PROJECT
NAME: l — �l�
REPORT NO:
ADDRESS: � % ��-�
CONTACT NAME:
PO NO: G%lC� %9.�- 33d
1,/ REPORT TO: PHONE/FAX:
COPY TO: email: /Y?j"
Sampled Bv: SAMPLE TYPE I = Influent_ F = Ffflunnf W = Won cT = c..e­ cn = 4Z„11 c1 - ee..s__ ,.
Sample Identification
PRESERVATION
ANALYSIS REQUESTED
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Temperature when Received: L-- Accepted: Rejected: Resample Requested:
Delivered By: tGvl /���✓ �i nS�P ✓ Received By: Date: Time:
Comments: TURNAROUND:
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