appendix a.4. - groundwater sample chain-of-custody … · · 2016-05-09~~~db . 2. v!v. i~...
TRANSCRIPT
Appendix A4 - Groundwater Sample Chain-of-Custody Forms
11 ~
middot~
Chain of Custody Record N~ ~-1604
Project Number ~f
Sampler (Print Name)~tgt-Wll~-Address Sampler (Print Name)
Shipment Method -eJ Alrbill Number _
Phone Laboratory Receiving
Fax
1ii I
Field Sample ID
11--ll- s ) lo 5 ~1~13LJg_j1IampJd5l 2 IV 717171 vi v s-) lfo1 ___ ____l_lQ$V _j__j_Lz I v1 v1 vt vi vi v
R(sect) PI- 110middot-SS g 1140 I I I I I I I lvlviV IPc-lto-ss 1 lD z3 1 1 1 L 1 vtvl1 ]vi 1-~- ll2
1 Comments SpeciatInstructions etc
_fD_ Q
GibSample 10 (10 b9 -~mpleteltl_trf_~b)
1ns- I I I 3 KI1 V] vi 1IV 133o I I I 2 hllvllv VI vfll-ICXHiS 1314
Imiddotmiddotmiddotmiddot -=r8-l- flrmiddot~-------D71il~h~
D-3 Pl-100-SJ)
Pz -liZ- AS blL 01 Pl-ZtllhSS D-65 P- f-SIgt S-EN
PH0t-S5 Pt-- 113 -A-1gt fPyen- 1i3- AS
RollnQUished by (Signature) __
Retlnqu1shed by (Signature
ISIlP
)1 ~~
ltltlO
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bllct1~13 t-M I I I z llvlviIVIv ti10~0U IOZ-3 I I I 2 lvl vllviVIv
I I05Z I I I 3 l_1 II vi 1 11-11 I I I z lvVIvl111 II I I I z Ivlv V I ~Igt nl3 _j_l _L z __ljLl_dVV 13o2shy I 1Y L z I vt-V I vllv Jl
n-holzoJHa~ ~~I s IV~~ II vi vl C]_ RecelveCI by SlQiliture) Date llme
FiN (phll G-feJ 1truJ oM Sample Custodian Remarks (Completed By Laboratory)
~te TimeRbullcmiddot~e)B~ ) 7 liS l1 1bi(J
Recef~~~~-~u~r~- ~~middot~-I Jampo
QAIOC Level I Turnaround I Sample Receipt
Total Containers Received Level I 0 Routine 0 COC Seals Present level II 0 24 Hour o COO Seals Intact level Ill 0 1Weok 0 Received Containers Intact Other 0 Olhor __ Temperature
RECD JUL 15 2013 13- 0 7 0 9 8 Eberlinamp Services ~middot ro1ScadgtoroRoad Iii EBERLINE oakRidge TN31830 SERVICES (865) 481-0083 Phone bull (865) 493-4621 Fax
(j) Pag_l_otl_
~1et~o4m3
PurchaseOrder tt________
middotmiddot-middotmiddot--------------------middot--middot middotmiddotmiddotmiddotmiddot---
RECD JUL 15 2013 13- 0 7 0 91 Eberllne Servlclts ~middot 601 Scalbolo RoadChain of Custody Record N~ 1604 oak Ridge TN 37830 IE B E R L I N E
SEIIYICES
-
Project Number fProject NamefJ ci kA Peuro()Yf ~1
Pagel_orl_Send Report ToA J l -middot Sampler (Print Name)~~- c)l~_ CDSampler (Print Name) Address~c JJ -rffgt_ Aft~
ft
1(1~ l rt~~ ni ~tec~ofShipment Method( _-esSk td2 ft ~ ~ +~Airbill Number _fAfcruwJ Go ~55
Purchase Phone amp ~ II Order Ipound___Laboratory Receiving
) ~ Fax
w ~ iB Lab sample ID J Comments Special lmple lmple Sample Number olField Sample ID ~fl ltS~ ~ ~~ (to be completed by tab)Instructions etc Date Time Matrix Containers
v ()v2to- 1 ~~~dB VvI~ bullV1-rt~3Pt- - 11 I - ~ ) f v (~ 2 vJo)V vv v vS-S
F6) Pt- 110--S~ v v1140 v L vIvl_l--110-SS ll3 v
v ~~ 3 I1~2-S vJ_ -if v o Pl-100 -ltSS vv2J33b
vv tgt-J v13-12 2 v v tPt--100-SIgt lif3L 2
V ~~ v vvNLffoPl -IlL- AS 2 o v v1-JA lbvP o1 t5 =ll1 ~3
rv v ~Pl-~IA-SS (II 1htgt IOZt5 z~03 v v ~--~ l v middottt -middot- - middot shy1~ 3 ~ rI)- 65 ~~ 1052 v ~ TOPrl- -~
tnv p- (fk-Sj) l I 2shy rI1-fl v vz v a
Pt--t8b -Sgt i ~
v vS-6~ 2 ~~ 114 v z V12-13 IJJII vPt-- lls -A-P f ll v vl3o2 V z vv 13 bullvshy ()1~ltXJ ~~P~- 113- PrS lholzoa
Relinquished by (Signature) Received by (Signature) nmeDate Sample Custodian Remarks (Completed By Laboratory)A
Sample ReceiptQAIOClevel TurnaroundFin+ (p-to (Cowt-e-J 1tJiul) ofhl--17 -I -_) l Total Containers Received lime
Level I 0 Routine 0Rece~)J~~ ~1st11 COC Seals Present 71Cby~J~ 1b40 Level II 0 24Hour 0 COC Seals Intact Received by (Signature) Date TimeRelinqUished by (Signature) level Ill 0 1 Week 0 Received Containers Intact
Other __Other 0~ ltr~~ 17-r s13 (oo Temperature
middot ~~
~
~ ~
-~middotmiddotmiddot-middotmiddotmiddot
RECD JUL 15 2013 13- 0 7 1 0 0 Eberllne Servlltes (bullChain of Custody Record N~ aot Scartlolo Road IE B E R L I N E1604 oak Ridge lN 37830 S E FlY ICES (865) 481middot0683 Phone bull (865)483-4621 Fax
Project Number I
Sampler (Print Name)~~-cdl~- middot(j) Paga_Lorl_
Address Sampler (Print Name) J1 ~tec~ofShipment Method ~
I
Alrbill Number _
Phone Laboratory Receiving
Fax
Reid Sample 10 Sample I sample I SampleDate Time Matrl~t
P~=~~--_-~-~ -- -firt1~~31 1o- L I~I 2 IV v1~ l(f7] v s-$ I bull lloSV I 1 I z I Vf v1 vt ~~J~
F6 P7- 11o--s~ I I 11140 I I I l I I I Iv1vlv Pl--llo-ss I I I rz3 I I I z_ Ivf7ll r7J7 l-4 I I l1z~r- I I 13 11 v1 vf1IV
Pl-I00-8S I I l163b I I I 2 lvlvllvllv D-3 I I IIJqz I I I 2 I vt vi vtVI vi v-Pc-10o-sigt I I J-3L I I I 2 1~1IVj vfIV Pr- -IlL- AS I i l14ttlo I I I 2 I vi __d II I v-1 v1 I bw o1 hlllltgt13 I t-LlA I I I z II lr I v-1 r Pl-~1) -ss flholOU I 101-l I I I 2 Ivi v1 vI vii D-- 6s --- I 4 l10sz I I I 3 I_(~ vr I1 vi Vl Pl-ltk-stgt I I l1t~1 I I I 2- IviVI ~~I v1 1 -s-6-1 I I llt41o I I I z I vlv V I1~17
Pc--teb -ss I I In~J I I I z I I~~ Iv-1 r-1 vi
J~ PurchaseOrder tt_______
j Comments SpecialInstructions etc
()
Lab sampre-ID (to be completed by lab)
Pt-- u3-A-J) 1 tb l13o2 1w 1 z 1vtrv 1vtv-l1 1 1 1 1 1 111 bull
middotmiddot ~~
IP~- I 3- AS------~ ~-5 Relinquished by (Signature)
~CcJ ~-~ J _t 2 tjt10TA-L- ~o7 (utiJ
QAIQC Level I Turnaround I Sample Receipt
Total Containers Received Level I 0 Rouline 0 COC Seals Present
Rellnquished6y(si9naturegt bull 1Recel~atureS~~-~~~31 Level Ill 0Wo Level II 0 24 Hour 0 COC Seals Intact 1 Week 0 Received Containers Intact
Other 0 Other_ Temperature
--0 _________ __ _________
RECD JUL15 Z01~ 3- 0 7 1 0 0 1 Eblrllne Services 601 Scalbolo RoadChain of Custody Record N~ ~-BERLINE1604 oak Ridge TN 37830 ~1 SERVICES (865) 481Q683 Phone bull (865) 493-4621 Fax
Project Number ltf Sampler (Print NameliJgtAA~tcWu -- (D PagapoundorL
Address Sampler (Print Name) ra 0 if J 5Mp~~o~Shipment Method
Airbill Number _
Phone Laboratory Receiving
Fax
Reid Sample ID
le=t-1al-~ ~
Pl- 1o~- ss t fup DL lU (
Pl-113-SS 11 ~
p~ -tCN-Ss $
P1-lot-SS n Pl- JQ~_sD liIC
FBQgt pl-- Ugtl -SS
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IP~- II)- SS DJP D~
--sample r-sampleDate Time
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ISOS I)LO
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Sample- j Number of Matrix Containers
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2 vfvl vt vt 3 vl~ Ivi lvV e_ v1v III I v1 ol Iv
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vl1 v1v1 v1 i v1 v1 vf1 vr v Vl I ~~I v1 1 -
tril ~ I
J~ Purchase
~L-middot--------------
I Comments Special Instructions etc
() ~
1
11 ill
Lali Sample-10 (to be completedby_labl
Date Time Sample Custodian Remarks (Completed By Laboratory)
QAJQCLevel I Turnaround I Sample Receipt
Total Containers Received Level I 0 RouUne 0 COC Saals Present Level II 0 24Hour 0 COC Seals Intact Level IllRelinquished by (Signature) ~nurReeelve~~ I~~S ~~ Jmz~ O 0 1 Week 0 Received Containers Intact Other 0 Other __
Temperatura
I
RECD JUL 15 2013 Ebertlne Srvlcl 601 Scarbolo RoChain of Custody Record Npound 1604 oak Ridge TN 37830 ~---middot--middotmiddot~-sectEAVICliS(865)481()683 Phone bull (865) 483-4821 Fax
-
Project Name(JJiff- ~~(_)yf Project Number
Jf ~~~~Send Report Tof-Av 1 J ~ Sampler (Print NameltJAAkJtJIt~u- (]) Pagapoundor3
IQY~7
Address~0 fJJ gt_ AA Sampler (Print Name)
51-f~~a~k l()G Shipment Method~~ J 1tt j
JW~~tarcdJ Go ~55 Airbin Number -~~ ~(Q~--- ~~ I Purchae
Phone LabolaiOI) Receiving I Order bull jFax t1
Q ~~middot] Lab ample IUReid Sample 10 gtJmple gt~mple Sample Number of VlcVlmiddotlt Commentsbull ~al
Date lime Matrix Containers Instructions etc (to be completed by lab)
IPt -1a1-ss 7raiMJ rY3o IA-~an z_ vlv v v ()
Pl- ~o-r- ~s fltc 7At) Js-3E3 f l v v v o ( fup OL fllt3l-M NV I z v v v
Pl-113-SS ~fu(l-obull3 Of3() z v v v v
Pt -teN -ss ~t i[Y1Hmiddot z_ v v v
Pl-Ot-SS Dll~ 2 v
Pl-o-1-SD )0~ 2 v v v v
FBQ) pl- 2-Dt -SS - 11-UO j I v v v
P1-- ~z-ss s(p 1132 1 z v v v v
l)- euro33 - ~ 13os- 31( v v If e-I~ ~lUI () - I 2-o Cf 1-0 11-(12 z v v v t~ ~rALmiddot
S-02 llt l-132- 2 v v v ~rc1l
P1- -IIV- ss 1gt N 150) 2 v v vmiddot v v
D-13 Sr ~~ JS10 l v I -
middotI-e I] 9 t~Lto z v v v v V
Pt--11)- ~ ltr 20 ~ b31o V z_ v 1 1 v v w
bJP OS =711bOI) t-Jl ~~ l () Relinquished by (Signature) Received Dy (Signature) Date nme Sample Custodian Remarks (Completed By laboratory)
~ gt k0middot+-~q--h GvJgtt ~tflo~J oJUgt QAIOC Level Turnaround Sample Receipt
Total Containers Received
Rez~ed~ Heceivea ~ (gtlgnature) oate lime
~~~Mamp~r 1 (tl 1 r(fr Level I 0 Routine 0 COC Seals Present
Level II 0 24 Hour 0 COC Seals Intact HellnqursheltJ t)y ()ignature) Received by (Signature) Date llme Level Ill 0 1 Week 0
~lt~ 1~~0 Received Containers Intact
7-15-1 2 Other 0 Other __ Temperature
J3
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Jj I ~
1111
w li
RECD J U L 15 2013 1
Ebefllne Service 601 Scatbolo RoChain of Custody Record N~ 1604 Oak Ridge TN 37830 ~----middot- ~middothRYICIS (BSS) 481()683 Phone bull (BSS) 483-4621 Fax
ie
I shy
Project Name() tLf- tA~CP-1 Project Number
~~iA~lfSend Report To~ L ~ Sampler (Print Name)iJgtAA~~ (]) PagapoundofL
Address~c (1 -rfD- A~ Sampler (Print Name) ~~~ol~-k L()G Shipment Method~ltiJ
0-fou~ Go ~35 Airbill Number t ~ ~ (JjJ J~- ~
1 c ~ I I Purchase
Phone laboratory Receiving Ordortt__ ~ ~ Fax
Reid Sample 10 Simple S_mple ~ample Number or ~~lt ~middot~~ Comments special lab Sample ID Date lime Matrix Containers Instructions etc (to be completed by lab)
IPt-1CA-ss F7ft~ho3 rY3o middotftp~ z vv V v () Pl- ~o-r- SS tl(c U1] S3E3 middot~f 2 v V v ( fup OL Jiti)~M Nll z v v v II
Pl-115-SS ~(11JOI) ofJmiddotrv l v v v v v v Pt-ICgtl-Ss ~ 0131 2- V v II
Pl-Oi-SS t)tttgt 2 v v lt
Pl-O~-SD )0~ l v v v v
r=Bamp Pl- -ugt-z-ss (~UO I v v v Pt-- UJmiddotz-ss 123 2 2 V v v )- 63 130) 3 o v v
~) -12-o-( llmiddot(i 2 e v
S-0t N3Z z v v v II -Pt- -IV- ss ISOS 2 v v v ---
1)-H ISllO l v IV I-t1 tJ1Uo z v v v a
lr~- 1rs-- ~s ~ b3to v z_ v v v v lj)
bJP D~ 45 111~_013 ~l~ ~~ l CD Relinquished by (Signature) Received by (Signature) Date nme Sample Custodian Remar11s (Completed By laboratory)
~- Hr-s-+-~cp--h Gvfle Ftt()WIJ oBw QAIQC level Turnaround Sample Receiptc gt Re7J~d~
ReceiVed by (Signature) Date Time Total Containers Received
~~~M6~Y 1 (fk1 I (I -( r Level I 0 Routine 0 COC Seals Present
Level II 0 24 Hour 0 COC Seals Intact Relinquished by (Signature) Received by (Signature) Date nme
Level Ill 0 1 Week 0 Received Containers Intact
~(1~ -SI 2 J(~o Other 0 Other-- Temperature
=RECD JULlP ~ 3 13-0 7111 Chain of Custody Record N~
middot SERVICES) 481()683 Phone (865) 483-4621 Fax E a E R L I N E1604 =-~~ Project Number Project Name(J J1Jt tA ~0gt-f lf Sampler (Print Name) Send Report ToAA I L-_- (D Pag~orL
clSSampler (Print Name) Address~o (J -r~- ~iamp) nrIf ~~~o(Shipment Method~ r(-ltzs
Airbill Number _
sk qJG ~ If~~fa~ Go 80J-55 I PurchaseOrder t_________
Laboratory Receiving Phone
Fax ample -comments Special UiliSamPle 10
Field Sample 10 (10 tMI completed til_lab)Instructions etc Date
s-~ (tz T-~z a- 4 D-b Iori(
smiddot-0~ I2 (_l I- tp lf If ] lPtgt l~f]
W_Q_ ~H [~ l~
1pound)_1JJJfJ31 Ot)ZJ I~I 2 1-1 l V Jl I An ld1~ I tr I 1middot IL1 vlll1 f
113S Ll L z Iv1 f I v-I 1 lt-omiddotz I I I 2- I v--1ll lv I
133 I I I J ltl1 vi lv II-- -~ G_fu~ ~middot 0IA
(sj TOTA-L orft1fl3~ ~~~ I I I ~ lVI ~ ~ ~1(-~fw) WltAshy middotz v pound v vshy
1111 -m~~ Sample Custodian Remarks (Completed By Laboratory)
QAIOC Level Turnaround Sample Receipt h~_______----------+i~r--~M~~~----+~~-+r=~--1 - - tolaJ iOma~ners Received
Level I 0 Routine 0 COC Seals Present 0 24 Hour 0 COC Seals Intact hl~~f~~~~r-JoC-~-+B=n-i-___rn-+if-----t Level II
Love Ill 0 1 Week Cl Received Containers IntactOther __Other 0 Temperatura
- ------
0 ~ i 4 6ECD JUL 22 2013 E~LI~E Eberllnt Servlca 601 ScalboiO RoadChain of Custody Record 13- ] ~EB ~SobullvocnN~ 1604 oak Rldgo TN 3830 (865) 481Q683 Phone bull (8651 483-4821 Fax
-middot shyProject Number Project Namef1 b~ tAk0gt-1
1 _ ~ Paga__l_ori_Sampler (Print Name) Send Report To~ JT ht~~ l (])I o$tr ~ Samplor (Print Name) Addressme (raquo -rfl) I A-~gt I -1 f ltsMf~~oShipment Method~ H-ei 0 f~middot-~e LCJG ~~ ns ~ ~ Airbill Number Ua~1 Go ~55 -1 1 Purchase - ~ ~ bull I Ordermiddot~Laboratory Receiving Phone ) ~
Fax Lab Sample IDNumber ors~mpleSimple C~ents_~~alSa~PIeField Sample 10 )J Itii (to be completed by lab)
Instructions etc ~ltcContainersDate Matrixlime
rr- f 3rd ~middott~ IIt)4WL middotLdfl 3 lvr t v-~lcd13Pl-IoS ss 5 v( middot~ 7()TA-t (1~ IOSw 21htfrlP~- II - A~ lDI ~v ~~ o11~middot~O(ct v81 rlt13 ~ lv v-I t+ fill~WIOZ- 01 1110 l l ~- vfcJ 03 2 3 affi p~ 3o3 -AS )- S 12-kgt ~ r r (lq I ( ZJI~I-H ttfCC)f vS-10 6 q vZ fl vlt~oF6~J D-Vl aJ ~~-12 lfZshy J N(A]Jp osshy llt1IJ z
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Relinquished by (Signature) Received by (Signature) Date nme Sample Custodian Rama111s (Completed By Laboratory)
OAOClevel Sample Receipt Turnaround~=- ~r t1-Jorl1~ - Jf-zw DfJuJ Total Containers Received Date llmekIVedDf (Signature)
level I 0 Routine 0 COC Seals Present (2) f1A A bull ~J ~~lt~ 1-1lt (
~~ Level II 0 24Hour 0 COO Seals Intact Received by (Slgnature) Date llmeI( ~nnquz 1gn~ level 111 0 1 Week 0 Received Containers Intact
Other __Other 0 Temperature
-- -
13-07147RECD JUL 22 2013
Ebertlne SeMen 601 SCalbolo RoadChain of Custody Record Npound 1604 oak Rldgo TN 31830 (865)481-tl683 Phone bull (665)483-4621 FIUI
Project Name(j ~ ~~()gt-- Project Number
Send Report To~ l -bull- ~ Sampler (Print Name) 1~-C )07
Address~c (raquo --rJi) ~ Samplor (Print Name)
~-le l()G Shipment Method~ rf~
iAfau~ 1 Go ~55 Airbill Number -Phone Laboratory Receiving
Fax
Field Sample ID s~mple Date
Slmple 1lme
Sample Matrix
P~-IOf ss Jict( 3 ~1- ~~ p_ If( -- A-l 1(ct(cl IOSw r
r fD( 1tf11 (O(ct
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A~ ~~~~~~~ ~w tJiD(
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f1nA jqjrlt -llnqu~ 1gnT Receivecl by (Slgnature)
Number or Containers
3 z_ 2
l~
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Jliifi1 CD Pagel_ori_
~~~oI ~ ~- ~
l~ I~ ~
Purchase
~ j Ofder
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t () IV v - t ~
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(j) Sample Custodian R8lnlllb (Completed By Laboratory)
QAJCiC Level Turnaround Sample Receipt
Date 11me Total Containers Received
~ln-lt~ 1-=l-15 Level I 0 RouUne 0 COC Seals Present Level II 0 24Hour 0 COC Seals Intact
uate Time Love Ill 0 1 Week 0 Received Containers Intact Other 0 Other __
Temperatura -middot--- middot--L___
middot
ln r (13
RECD JUL 2 2 201313~07149 abertlne Servtca 601 SCtuboto ROioCIChain of Custody Record N~ 1604 Oak Rlclgo TN 37830
EBERLI~E~ SCAYICCS
865) 481Q683 Phone bull (865) 483-4621 Fax
Project Name(J ~ ti k()Yf Send Report To~ IM--d Address~o fJJ ~ipound ~middot-~e tcfJ ~ka~Go ~55 Phone
Fax
Field Sample 10
Project Number
Sampler (Print Name)
Sampler (Print Name)
Shipment Method~ H-laquoS
Airbill Number -Laboratory Receiving
Sample Date
SamPfe Time
Sample Matrix
1 ~ J
(D Pag~orS
~~~of If~
PurchaseOfder __________
-COmments Special Instructions etc
Cab-samPle ID (to be complet~~lab)
P _ Jol AS 4~ llfcfc1 Jrrao IA-~1 t __ l~~ 1111-JI _ () lllr~il3 I IOU if I Z I_IVI-1-11-Lit-_lJ[t c I
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Z 1-1 -1 -t r -1-1 I I I I I _ill Date nme Sample Custodian Remarks (Completed By Laboratory)
yen 3cJ tl11c~ 5~~middot~
07~e
i-=1~rIJ Io6co QNQC Level Turnaround Sample Receipt
Total Containers Received1 Date bull llme I 0 q_J2Z II 0 Date Ill 0
Routine 0 COC Seals Present
24 Hour 0 COC Seals Intact
1 Week 0 Received Containers Intact Other 0 Other-- Temperatura
i
I
13-0152
Chain of Custody Record N~ IVVt oak Ridge TN 37830 SIIIIYICES~---middot--middotmiddot-== t865l 481-lt1683 Phone bull (865) 483-4621 Fax
It
n
-
Project Name) tJff tAk0gt-1 Project Number
t~JIISend Report Tof-)v[ _ gt Sampler (Print Name) (D
Page Z-or_J_
Addressmc (JJr~ AJa Sampler (Print Name)
~telt~ofSk~ Shipment Method~~ rfir ~ ns
~~lh rcb Go ~35 Airbill Number _ -~~ n1ltP~ J~ ~~ ~~ I l Pu~~~e
Phone Laboratory Receiving -) j
Ofder
Fax f7 ~ i~ ~
Field Sample 10 sample i_mple sample Number of -~ltlt Q fJ Comments ~al Lab Sample 10 Date Time Matrix Containers Instructions etc (to be completed by labl
P-Jol AS =lflampfc1 rr3o ~~~dfi l ~v 1 ()
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RECD JUL 22 2013 middot~E BER L I N E Chain of Custody Record ---601 SCa1bo10 Road N~ 1604 oak Rldgo TN3830 SERVICES
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13-07154 RECD JUL 2 2 2013 Eberllnt Servlcu 601 Scamoro RoadChain of Custody Record N~ 1604 oak Ridgo TN 37830 ~EBERLI~E
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13-07170 Ebertlne SeMcea 601 Slteltloro RoadChain of Custody Record N~ (EBERLI~E1604 oak Ridge TN 31830 SCIIVICES (865) 48Hl683 Fttone bull (865 483-4621 Fax -
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13-07147RECD JUL 22 2013
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RECD JUL 2 2 201313~07149 abertlne Servtca 601 SCtuboto ROioCIChain of Custody Record N~ 1604 Oak Rlclgo TN 37830
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RECD JUL 22 2013 middot~E BER L I N E Chain of Custody Record ---601 SCa1bo10 Road N~ 1604 oak Rldgo TN3830 SERVICES
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13-07153 RECD JUL 2 2 2013
Eberllne Service~ ~ 601 Sealboto RoadChain of Custody Record N~ 1604 oak Ridge TN 37830 ~E B ERr_~N_f (865) 48Hl683 Phone bull (865) 483-4821 Fax
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-- -
13-07154 RECD JUL 2 2 2013 Eberllnt Servlcu 601 Scamoro RoadChain of Custody Record N~ 1604 oak Ridgo TN 37830 ~EBERLI~E
SeRVIcEs (865) 48Hl683 Phone bull (865) 483-4621 Fax
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13-07170 Ebertlne SeMcea 601 Slteltloro RoadChain of Custody Record N~ (EBERLI~E1604 oak Ridge TN 31830 SCIIVICES (865) 48Hl683 Fttone bull (865 483-4621 Fax -
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middotmiddot-middotmiddot--------------------middot--middot middotmiddotmiddotmiddotmiddot---
RECD JUL 15 2013 13- 0 7 0 91 Eberllne Servlclts ~middot 601 Scalbolo RoadChain of Custody Record N~ 1604 oak Ridge TN 37830 IE B E R L I N E
SEIIYICES
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RECD JUL 15 2013 13- 0 7 1 0 0 Eberllne Servlltes (bullChain of Custody Record N~ aot Scartlolo Road IE B E R L I N E1604 oak Ridge lN 37830 S E FlY ICES (865) 481middot0683 Phone bull (865)483-4621 Fax
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RECD JUL15 Z01~ 3- 0 7 1 0 0 1 Eblrllne Services 601 Scalbolo RoadChain of Custody Record N~ ~-BERLINE1604 oak Ridge TN 37830 ~1 SERVICES (865) 481Q683 Phone bull (865) 493-4621 Fax
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RECD JUL 15 2013 Ebertlne Srvlcl 601 Scarbolo RoChain of Custody Record Npound 1604 oak Ridge TN 37830 ~---middot--middotmiddot~-sectEAVICliS(865)481()683 Phone bull (865) 483-4821 Fax
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RECD J U L 15 2013 1
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0 ~ i 4 6ECD JUL 22 2013 E~LI~E Eberllnt Servlca 601 ScalboiO RoadChain of Custody Record 13- ] ~EB ~SobullvocnN~ 1604 oak Rldgo TN 3830 (865) 481Q683 Phone bull (8651 483-4821 Fax
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13-07147RECD JUL 22 2013
Ebertlne SeMen 601 SCalbolo RoadChain of Custody Record Npound 1604 oak Rldgo TN 31830 (865)481-tl683 Phone bull (665)483-4621 FIUI
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RECD JUL 2 2 201313~07149 abertlne Servtca 601 SCtuboto ROioCIChain of Custody Record N~ 1604 Oak Rlclgo TN 37830
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RECD JUL 22 2013 middot~E BER L I N E Chain of Custody Record ---601 SCa1bo10 Road N~ 1604 oak Rldgo TN3830 SERVICES
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13-07153 RECD JUL 2 2 2013
Eberllne Service~ ~ 601 Sealboto RoadChain of Custody Record N~ 1604 oak Ridge TN 37830 ~E B ERr_~N_f (865) 48Hl683 Phone bull (865) 483-4821 Fax
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RECD JUL 15 2013 13- 0 7 1 0 0 Eberllne Servlltes (bullChain of Custody Record N~ aot Scartlolo Road IE B E R L I N E1604 oak Ridge lN 37830 S E FlY ICES (865) 481middot0683 Phone bull (865)483-4621 Fax
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Ebertlne SeMen 601 SCalbolo RoadChain of Custody Record Npound 1604 oak Rldgo TN 31830 (865)481-tl683 Phone bull (665)483-4621 FIUI
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RECD JUL 22 2013 middot~E BER L I N E Chain of Custody Record ---601 SCa1bo10 Road N~ 1604 oak Rldgo TN3830 SERVICES
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13-07153 RECD JUL 2 2 2013
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13-07154 RECD JUL 2 2 2013 Eberllnt Servlcu 601 Scamoro RoadChain of Custody Record N~ 1604 oak Ridgo TN 37830 ~EBERLI~E
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13-07170 Ebertlne SeMcea 601 Slteltloro RoadChain of Custody Record N~ (EBERLI~E1604 oak Ridge TN 31830 SCIIVICES (865) 48Hl683 Fttone bull (865 483-4621 Fax -
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--0 _________ __ _________
RECD JUL15 Z01~ 3- 0 7 1 0 0 1 Eblrllne Services 601 Scalbolo RoadChain of Custody Record N~ ~-BERLINE1604 oak Ridge TN 37830 ~1 SERVICES (865) 481Q683 Phone bull (865) 493-4621 Fax
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RECD JUL 15 2013 Ebertlne Srvlcl 601 Scarbolo RoChain of Custody Record Npound 1604 oak Ridge TN 37830 ~---middot--middotmiddot~-sectEAVICliS(865)481()683 Phone bull (865) 483-4821 Fax
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13-07147RECD JUL 22 2013
Ebertlne SeMen 601 SCalbolo RoadChain of Custody Record Npound 1604 oak Rldgo TN 31830 (865)481-tl683 Phone bull (665)483-4621 FIUI
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Chain of Custody Record N~ IVVt oak Ridge TN 37830 SIIIIYICES~---middot--middotmiddot-== t865l 481-lt1683 Phone bull (865) 483-4621 Fax
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RECD JUL 22 2013 middot~E BER L I N E Chain of Custody Record ---601 SCa1bo10 Road N~ 1604 oak Rldgo TN3830 SERVICES
865) 481Q683 PhOnemiddot (865) 483-4621 Fu __ middot
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13-07153 RECD JUL 2 2 2013
Eberllne Service~ ~ 601 Sealboto RoadChain of Custody Record N~ 1604 oak Ridge TN 37830 ~E B ERr_~N_f (865) 48Hl683 Phone bull (865) 483-4821 Fax
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-- -
13-07154 RECD JUL 2 2 2013 Eberllnt Servlcu 601 Scamoro RoadChain of Custody Record N~ 1604 oak Ridgo TN 37830 ~EBERLI~E
SeRVIcEs (865) 48Hl683 Phone bull (865) 483-4621 Fax
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Ebertlne SeMen 1J - O] ~middot D
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13-07170 Ebertlne SeMcea 601 Slteltloro RoadChain of Custody Record N~ (EBERLI~E1604 oak Ridge TN 31830 SCIIVICES (865) 48Hl683 Fttone bull (865 483-4621 Fax -
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RECD JUL 15 2013 Ebertlne Srvlcl 601 Scarbolo RoChain of Custody Record Npound 1604 oak Ridge TN 37830 ~---middot--middotmiddot~-sectEAVICliS(865)481()683 Phone bull (865) 483-4821 Fax
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RECD J U L 15 2013 1
Ebefllne Service 601 Scatbolo RoChain of Custody Record N~ 1604 Oak Ridge TN 37830 ~----middot- ~middothRYICIS (BSS) 481()683 Phone bull (BSS) 483-4621 Fax
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0 ~ i 4 6ECD JUL 22 2013 E~LI~E Eberllnt Servlca 601 ScalboiO RoadChain of Custody Record 13- ] ~EB ~SobullvocnN~ 1604 oak Rldgo TN 3830 (865) 481Q683 Phone bull (8651 483-4821 Fax
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13-07147RECD JUL 22 2013
Ebertlne SeMen 601 SCalbolo RoadChain of Custody Record Npound 1604 oak Rldgo TN 31830 (865)481-tl683 Phone bull (665)483-4621 FIUI
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Chain of Custody Record N~ IVVt oak Ridge TN 37830 SIIIIYICES~---middot--middotmiddot-== t865l 481-lt1683 Phone bull (865) 483-4621 Fax
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13-07~53
RECD JUL 22 2013 middot~E BER L I N E Chain of Custody Record ---601 SCa1bo10 Road N~ 1604 oak Rldgo TN3830 SERVICES
865) 481Q683 PhOnemiddot (865) 483-4621 Fu __ middot
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13-07153 RECD JUL 2 2 2013
Eberllne Service~ ~ 601 Sealboto RoadChain of Custody Record N~ 1604 oak Ridge TN 37830 ~E B ERr_~N_f (865) 48Hl683 Phone bull (865) 483-4821 Fax
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Other 0 Other __ Temperature--L_______ -
-- -
13-07154 RECD JUL 2 2 2013 Eberllnt Servlcu 601 Scamoro RoadChain of Custody Record N~ 1604 oak Ridgo TN 37830 ~EBERLI~E
SeRVIcEs (865) 48Hl683 Phone bull (865) 483-4621 Fax
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13-07170 Ebertlne SeMcea 601 Slteltloro RoadChain of Custody Record N~ (EBERLI~E1604 oak Ridge TN 31830 SCIIVICES (865) 48Hl683 Fttone bull (865 483-4621 Fax -
Project NameTJtJ-~- [A kQgt--- Project Number
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RECD J U L 15 2013 1
Ebefllne Service 601 Scatbolo RoChain of Custody Record N~ 1604 Oak Ridge TN 37830 ~----middot- ~middothRYICIS (BSS) 481()683 Phone bull (BSS) 483-4621 Fax
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13-07147RECD JUL 22 2013
Ebertlne SeMen 601 SCalbolo RoadChain of Custody Record Npound 1604 oak Rldgo TN 31830 (865)481-tl683 Phone bull (665)483-4621 FIUI
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RECD JUL 2 2 201313~07149 abertlne Servtca 601 SCtuboto ROioCIChain of Custody Record N~ 1604 Oak Rlclgo TN 37830
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13-0152
Chain of Custody Record N~ IVVt oak Ridge TN 37830 SIIIIYICES~---middot--middotmiddot-== t865l 481-lt1683 Phone bull (865) 483-4621 Fax
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13-07~53
RECD JUL 22 2013 middot~E BER L I N E Chain of Custody Record ---601 SCa1bo10 Road N~ 1604 oak Rldgo TN3830 SERVICES
865) 481Q683 PhOnemiddot (865) 483-4621 Fu __ middot
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~~~ qJ2Z I 19-IT ~eve II 0 level I 0 Routine 0 COC Seals Present
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13-07153 RECD JUL 2 2 2013
Eberllne Service~ ~ 601 Sealboto RoadChain of Custody Record N~ 1604 oak Ridge TN 37830 ~E B ERr_~N_f (865) 48Hl683 Phone bull (865) 483-4821 Fax
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Other 0 Other __ Temperature--L_______ -
-- -
13-07154 RECD JUL 2 2 2013 Eberllnt Servlcu 601 Scamoro RoadChain of Custody Record N~ 1604 oak Ridgo TN 37830 ~EBERLI~E
SeRVIcEs (865) 48Hl683 Phone bull (865) 483-4621 Fax
Project Number
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Othat 0 Othat_ Temperature
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- -
Ebertlne SeMen 1J - O] ~middot D
601 Sltaltlolo RoadChain of Custody Record N~ 1604 Oak Ridge TN 37830 E B E R L I N E 865) 481middot0683 Phone (865) 483-4621 Fax SERYIC Es
Project Name(iiiijf ~kJgt- Project Number
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~~Nmiddot iJn CuO LtrA 1c(r3 ca-D level I 0 Routine CJ COC Seals Present Level II 0 24Hour 0 COC Seals Intact
RelfnqUished by (Signature) Received by (Signature) Date nme Level til 0 1 Week o Received Containers Intact Other 0 Other __
Temperature
13-07170 Ebertlne SeMcea 601 Slteltloro RoadChain of Custody Record N~ (EBERLI~E1604 oak Ridge TN 31830 SCIIVICES (865) 48Hl683 Fttone bull (865 483-4621 Fax -
Project NameTJtJ-~- [A kQgt--- Project Number
Send Report Tof-1rvJ Jk~ ~ Sampler (Print Name)
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- -
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~~ ~(JJ~ ~ ~~ I~ Purch~se
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~ Level I 0 Routine 0 COC Seals Present level II 0 24Hour 0 COC Seals Intact
nme Level Ill 0 1 Week a Received Containers Intact Other 0 Other __
Temperature
I
I
I I
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=RECD JULlP ~ 3 13-0 7111 Chain of Custody Record N~
middot SERVICES) 481()683 Phone (865) 483-4621 Fax E a E R L I N E1604 =-~~ Project Number Project Name(J J1Jt tA ~0gt-f lf Sampler (Print Name) Send Report ToAA I L-_- (D Pag~orL
clSSampler (Print Name) Address~o (J -r~- ~iamp) nrIf ~~~o(Shipment Method~ r(-ltzs
Airbill Number _
sk qJG ~ If~~fa~ Go 80J-55 I PurchaseOrder t_________
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0 ~ i 4 6ECD JUL 22 2013 E~LI~E Eberllnt Servlca 601 ScalboiO RoadChain of Custody Record 13- ] ~EB ~SobullvocnN~ 1604 oak Rldgo TN 3830 (865) 481Q683 Phone bull (8651 483-4821 Fax
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-- -
13-07147RECD JUL 22 2013
Ebertlne SeMen 601 SCalbolo RoadChain of Custody Record Npound 1604 oak Rldgo TN 31830 (865)481-tl683 Phone bull (665)483-4621 FIUI
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RECD JUL 22 2013 middot~E BER L I N E Chain of Custody Record ---601 SCa1bo10 Road N~ 1604 oak Rldgo TN3830 SERVICES
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13-07153 RECD JUL 2 2 2013
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13-07154 RECD JUL 2 2 2013 Eberllnt Servlcu 601 Scamoro RoadChain of Custody Record N~ 1604 oak Ridgo TN 37830 ~EBERLI~E
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13-07170 Ebertlne SeMcea 601 Slteltloro RoadChain of Custody Record N~ (EBERLI~E1604 oak Ridge TN 31830 SCIIVICES (865) 48Hl683 Fttone bull (865 483-4621 Fax -
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- ------
0 ~ i 4 6ECD JUL 22 2013 E~LI~E Eberllnt Servlca 601 ScalboiO RoadChain of Custody Record 13- ] ~EB ~SobullvocnN~ 1604 oak Rldgo TN 3830 (865) 481Q683 Phone bull (8651 483-4821 Fax
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Ebertlne SeMen 601 SCalbolo RoadChain of Custody Record Npound 1604 oak Rldgo TN 31830 (865)481-tl683 Phone bull (665)483-4621 FIUI
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RECD JUL 22 2013 middot~E BER L I N E Chain of Custody Record ---601 SCa1bo10 Road N~ 1604 oak Rldgo TN3830 SERVICES
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13-07153 RECD JUL 2 2 2013
Eberllne Service~ ~ 601 Sealboto RoadChain of Custody Record N~ 1604 oak Ridge TN 37830 ~E B ERr_~N_f (865) 48Hl683 Phone bull (865) 483-4821 Fax
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13-07154 RECD JUL 2 2 2013 Eberllnt Servlcu 601 Scamoro RoadChain of Custody Record N~ 1604 oak Ridgo TN 37830 ~EBERLI~E
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13-07147RECD JUL 22 2013
Ebertlne SeMen 601 SCalbolo RoadChain of Custody Record Npound 1604 oak Rldgo TN 31830 (865)481-tl683 Phone bull (665)483-4621 FIUI
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13-07153 RECD JUL 2 2 2013
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-- -
13-07154 RECD JUL 2 2 2013 Eberllnt Servlcu 601 Scamoro RoadChain of Custody Record N~ 1604 oak Ridgo TN 37830 ~EBERLI~E
SeRVIcEs (865) 48Hl683 Phone bull (865) 483-4621 Fax
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13-07170 Ebertlne SeMcea 601 Slteltloro RoadChain of Custody Record N~ (EBERLI~E1604 oak Ridge TN 31830 SCIIVICES (865) 48Hl683 Fttone bull (865 483-4621 Fax -
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Page 5 of 26 872013
RECD JUL 2 2 201313~07149 abertlne Servtca 601 SCtuboto ROioCIChain of Custody Record N~ 1604 Oak Rlclgo TN 37830
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Chain of Custody Record N~ IVVt oak Ridge TN 37830 SIIIIYICES~---middot--middotmiddot-== t865l 481-lt1683 Phone bull (865) 483-4621 Fax
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RECD JUL 22 2013 middot~E BER L I N E Chain of Custody Record ---601 SCa1bo10 Road N~ 1604 oak Rldgo TN3830 SERVICES
865) 481Q683 PhOnemiddot (865) 483-4621 Fu __ middot
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13-07153 RECD JUL 2 2 2013
Eberllne Service~ ~ 601 Sealboto RoadChain of Custody Record N~ 1604 oak Ridge TN 37830 ~E B ERr_~N_f (865) 48Hl683 Phone bull (865) 483-4821 Fax
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13-07154 RECD JUL 2 2 2013 Eberllnt Servlcu 601 Scamoro RoadChain of Custody Record N~ 1604 oak Ridgo TN 37830 ~EBERLI~E
SeRVIcEs (865) 48Hl683 Phone bull (865) 483-4621 Fax
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13-07170 Ebertlne SeMcea 601 Slteltloro RoadChain of Custody Record N~ (EBERLI~E1604 oak Ridge TN 31830 SCIIVICES (865) 48Hl683 Fttone bull (865 483-4621 Fax -
Project NameTJtJ-~- [A kQgt--- Project Number
Send Report Tof-1rvJ Jk~ ~ Sampler (Print Name)
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I
I
I I
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Page 5 of 26 872013
13-0152
Chain of Custody Record N~ IVVt oak Ridge TN 37830 SIIIIYICES~---middot--middotmiddot-== t865l 481-lt1683 Phone bull (865) 483-4621 Fax
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13-07~53
RECD JUL 22 2013 middot~E BER L I N E Chain of Custody Record ---601 SCa1bo10 Road N~ 1604 oak Rldgo TN3830 SERVICES
865) 481Q683 PhOnemiddot (865) 483-4621 Fu __ middot
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13-07153 RECD JUL 2 2 2013
Eberllne Service~ ~ 601 Sealboto RoadChain of Custody Record N~ 1604 oak Ridge TN 37830 ~E B ERr_~N_f (865) 48Hl683 Phone bull (865) 483-4821 Fax
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Other 0 Other __ Temperature--L_______ -
-- -
13-07154 RECD JUL 2 2 2013 Eberllnt Servlcu 601 Scamoro RoadChain of Custody Record N~ 1604 oak Ridgo TN 37830 ~EBERLI~E
SeRVIcEs (865) 48Hl683 Phone bull (865) 483-4621 Fax
Project Number
Send Report To~
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13-07170 Ebertlne SeMcea 601 Slteltloro RoadChain of Custody Record N~ (EBERLI~E1604 oak Ridge TN 31830 SCIIVICES (865) 48Hl683 Fttone bull (865 483-4621 Fax -
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13-07~53
RECD JUL 22 2013 middot~E BER L I N E Chain of Custody Record ---601 SCa1bo10 Road N~ 1604 oak Rldgo TN3830 SERVICES
865) 481Q683 PhOnemiddot (865) 483-4621 Fu __ middot
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--- -
13-07153 RECD JUL 2 2 2013
Eberllne Service~ ~ 601 Sealboto RoadChain of Custody Record N~ 1604 oak Ridge TN 37830 ~E B ERr_~N_f (865) 48Hl683 Phone bull (865) 483-4821 Fax
111
Project NamefJfiJt_ (A~(P-1 Project Number
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LPJOJvvv L ~h12ll level I 0 RouUno 0 COC Seals Present
tmiddot91~ level II 0 24Hour 0 COC Seals Intact ~vnQUIShmiddot~l Recelveo by (Signature) Date llme level til o 1Week 0 Received Containers Intact
Other 0 Other __ Temperature--L_______ -
-- -
13-07154 RECD JUL 2 2 2013 Eberllnt Servlcu 601 Scamoro RoadChain of Custody Record N~ 1604 oak Ridgo TN 37830 ~EBERLI~E
SeRVIcEs (865) 48Hl683 Phone bull (865) 483-4621 Fax
Project Number
Send Report To~
Project Name() tiffshy (Ak0gt-1 )_ Pagdo~Sampler (Print Name)
cDSampler (Print Name) Address~0 ) fD_- lk Jl ~lf ~~~aShipment Melhod(Q v-1~
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OAIOClevel Sample Receipt Turnaround~~ lftrs ~-~ Gwlu F1~7Jo oScraquo ~ Total Containers Received Rei 111y (Signature) ReceiVed by Signature) Date ume
Level I 0 RouUno 0 COC Seals Present ~~ rPJ~(JI~A (ti-s- Level II 0 24 Hour []~h2J coc Seals Intact Heee1veo by (~Jgnature) Date Time~nQUISh~ tl Love Ill 0 1 Week Cl Received Containers Intact ~
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601 Sltaltlolo RoadChain of Custody Record N~ 1604 Oak Ridge TN 37830 E B E R L I N E 865) 481middot0683 Phone (865) 483-4621 Fax SERYIC Es
Project Name(iiiijf ~kJgt- Project Number
~l~ lSend Report To~ )_ middotmiddotshy Sampler (Print NamegtQOLl~o-Q
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RelfnqUished by (Signature) Received by (Signature) Date nme Level til 0 1 Week o Received Containers Intact Other 0 Other __
Temperature
13-07170 Ebertlne SeMcea 601 Slteltloro RoadChain of Custody Record N~ (EBERLI~E1604 oak Ridge TN 31830 SCIIVICES (865) 48Hl683 Fttone bull (865 483-4621 Fax -
Project NameTJtJ-~- [A kQgt--- Project Number
Send Report Tof-1rvJ Jk~ ~ Sampler (Print Name)
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S-tk~ Shipment Method~~
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Temperature
I
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--- -
13-07153 RECD JUL 2 2 2013
Eberllne Service~ ~ 601 Sealboto RoadChain of Custody Record N~ 1604 oak Ridge TN 37830 ~E B ERr_~N_f (865) 48Hl683 Phone bull (865) 483-4821 Fax
111
Project NamefJfiJt_ (A~(P-1 Project Number
~ middot~ ~Send Report To~ 1-~ Sampler (Print Name) Joj~- ~ CD Page__lor1_
Addressme ) -r-11gt_ Apound Sampler (Print Name) 5+-tf~~oSlelpoundJG Shipment Method~ ~ 0 f
t_~~A Go ~55 Airbill Number _ t ~ n1 ~ ~
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_llPo1 0 l liB r3 N ILdfi v t t 1 ()
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LPJOJvvv L ~h12ll level I 0 RouUno 0 COC Seals Present
tmiddot91~ level II 0 24Hour 0 COC Seals Intact ~vnQUIShmiddot~l Recelveo by (Signature) Date llme level til o 1Week 0 Received Containers Intact
Other 0 Other __ Temperature--L_______ -
-- -
13-07154 RECD JUL 2 2 2013 Eberllnt Servlcu 601 Scamoro RoadChain of Custody Record N~ 1604 oak Ridgo TN 37830 ~EBERLI~E
SeRVIcEs (865) 48Hl683 Phone bull (865) 483-4621 Fax
Project Number
Send Report To~
Project Name() tiffshy (Ak0gt-1 )_ Pagdo~Sampler (Print Name)
cDSampler (Print Name) Address~0 ) fD_- lk Jl ~lf ~~~aShipment Melhod(Q v-1~
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Level I 0 RouUno 0 COC Seals Present ~~ rPJ~(JI~A (ti-s- Level II 0 24 Hour []~h2J coc Seals Intact Heee1veo by (~Jgnature) Date Time~nQUISh~ tl Love Ill 0 1 Week Cl Received Containers Intact ~
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601 Sltaltlolo RoadChain of Custody Record N~ 1604 Oak Ridge TN 37830 E B E R L I N E 865) 481middot0683 Phone (865) 483-4621 Fax SERYIC Es
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13-07170 Ebertlne SeMcea 601 Slteltloro RoadChain of Custody Record N~ (EBERLI~E1604 oak Ridge TN 31830 SCIIVICES (865) 48Hl683 Fttone bull (865 483-4621 Fax -
Project NameTJtJ-~- [A kQgt--- Project Number
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-- -
13-07154 RECD JUL 2 2 2013 Eberllnt Servlcu 601 Scamoro RoadChain of Custody Record N~ 1604 oak Ridgo TN 37830 ~EBERLI~E
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13-07170 Ebertlne SeMcea 601 Slteltloro RoadChain of Custody Record N~ (EBERLI~E1604 oak Ridge TN 31830 SCIIVICES (865) 48Hl683 Fttone bull (865 483-4621 Fax -
Project NameTJtJ-~- [A kQgt--- Project Number
Send Report Tof-1rvJ Jk~ ~ Sampler (Print Name)
Address~0 ) -ifi- 71-ampl Sampler (Print Name)
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- -
Ebertlne SeMen 1J - O] ~middot D
601 Sltaltlolo RoadChain of Custody Record N~ 1604 Oak Ridge TN 37830 E B E R L I N E 865) 481middot0683 Phone (865) 483-4621 Fax SERYIC Es
Project Name(iiiijf ~kJgt- Project Number
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~ Relinquished by (Signature) Received by Signature) Date Tbullme Total Containers Received
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13-07170 Ebertlne SeMcea 601 Slteltloro RoadChain of Custody Record N~ (EBERLI~E1604 oak Ridge TN 31830 SCIIVICES (865) 48Hl683 Fttone bull (865 483-4621 Fax -
Project NameTJtJ-~- [A kQgt--- Project Number
Send Report Tof-1rvJ Jk~ ~ Sampler (Print Name)
Address~0 ) -ifi- 71-ampl Sampler (Print Name)
S-tk~ Shipment Method~~
~~n rwocb 1 Go ~55 Airbill Number -Phone laboratory Receiving
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13-07170 Ebertlne SeMcea 601 Slteltloro RoadChain of Custody Record N~ (EBERLI~E1604 oak Ridge TN 31830 SCIIVICES (865) 48Hl683 Fttone bull (865 483-4621 Fax -
Project NameTJtJ-~- [A kQgt--- Project Number
Send Report Tof-1rvJ Jk~ ~ Sampler (Print Name)
Address~0 ) -ifi- 71-ampl Sampler (Print Name)
S-tk~ Shipment Method~~
~~n rwocb 1 Go ~55 Airbill Number -Phone laboratory Receiving
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Field Sample ID Smple S_mple ~mple Number or Date Time Matrix Containers
-Pw~ 7Nt 0 ~Uhl t)fO ~L cJf) f f
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~~ ~eelb~Signature) Received by ~nature) Date
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-~~brA l~ iZIrJ Relinquished by (Signature) Hecetvea by (Signature) Date
- -
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~ Level I 0 Routine 0 COC Seals Present level II 0 24Hour 0 COC Seals Intact
nme Level Ill 0 1 Week a Received Containers Intact Other 0 Other __
Temperature
I
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