Document wqOZn5JKjexZz132VjYxKBZXo

Precise Research. P roven Results. Analytical Report Fluorochemical Characterization of Aqueous Samples Decatur Outfall 001 FC Monitoring (E06-0366) Exygen Research Laboratory Report No. L0008988 Testing Laboratory Exygen Research 3058 Research Drive State College, PA 16801 Requester Gary . Hohenstein Environmental Manager, Special Projects, EHS Operations 3M Bldq, 42-2E-27 St. Paul, MN 55133 ,3058 Research D rive State College, PA 16801, USA P` : 800.281.3219 F: 8 1 4 .2 7 2 .1 0 1 9 exygen.com 1 Introduction Results are reported for the analysis of aqueous samples received by Exygen Research (Exygen) from PACE Analytical. The Exygen study number assigned to the project is L0008988. Specific fluorochemical characterization by liquid chromatography / tandem mass spectrometry (LC/MS/MS) was requested for all samples. A total of 8 samples (including field duplicates, blanks, and spikes) were received for analysis. The samples were prepared and analyzed by LC/MS/MS for the following list of fluorochemicals: Table 1: Target Analysis Compound Name Perfluorobutanesulfonate (PFBS) Perfluorohexanesulfonate (PFHS) Perfiuorooctanesulfonate (PFOS) Perfluorobutvric Acid Perfluorooentanoic Acid Perfluorohexanoic Acid Perfluoroheptanoic Acid Perfluorooctanoic Acid Perfluorononanoic Acid Perfluorodecanoic Acid Perfluoroundecanoic Acid Perfluorododecanoic Acid Perfluorobutanesulfonamide (PFB Amide) Perfluorooctanesulfonamide 2-(N-methvlperluorobutanesulfonamido)ethvl alcohol Acronym C4 Sulfonate C6 Sulfonate C8 Sulfonate C4 Acid C5 Acid C6 Acid C7 Acid C8 Acid C9 Acid C10 Acid C11 Acid C12 Acid FBSA FOSA Me-FBSE-OH The analytical methods used were originally developed for groundwater samples and were validated by Exygen. The validation protocol and results are on file with Exygen. Only the C8 Sulfonate, FOSA, and C8 Acid were included in the original method validation. It should be noted that the quality control elements included in this analysis demonstrate the applicability of the method to the additional analytes. 2 Sample Receipt The water samples were submitted in plastic containers. Samples were received at ambient temperature. Samples were stored at 4C from receipt until analysis. Eight individual containers were received. Field samples were collected on 6/27/06 and 6/28/06. Samples were received on 6/29/06. Chain-of-custody information is presented in Attachment C. PAGE 2 OF 5 3 Holding Times Field and laboratory spikes of these fluorochemicals have shown stability for periods greater than 90 days. Samples were analyzed within 60 days of collection. 4 Methods - Analytical and Preparatory 4.1 LC/MS/MS 4.1.1 Sample Preparation for LC/MS/MS Analysis Water samples were initially treated with 200 uL of 250 mg/L sodium thiosulfate solution to remove residual chlorine. Solid phase extraction (SPE) was used to prepare the samples for LC/MS/MS analysis. A 40 mL portion of sample was transferred to a C18 SPE cartridge. The cartridge was eluted with 5 mL of 100% methanol. This treatment resulted in an eight-fold concentration of the diluted samples prior to analysis. 4.1.2 Sample Analysis by LC/MS/MS In HPLC, an aliquot of extract is injected and passed through a liquid-phase chromatographic column. Based on the affinity of the analyte for the stationary phase in the column relative to the liquid mobile phase, the analyte is retained for a characteristic amount of time. Following HPLC separation, ES/MS provides a rapid and accurate means for analyzing a wide range of organic compounds, including fluorochemicals. Electrospray is generally operated at relatively mild temperatures; molecules are ionized, fragmented, and detected. Ions characteristic of known fluorochemicals are observed and quantitated against standards. A Hewlett-Packard HP1100 HPLC system coupled to a PE Sciex API 4000 MS/MS was used to analyze the sample extracts. Analysis was performed using selected reaction monitoring (SRM). Samples were extracted and analyzed between 7/5/06 and 7/25/06. Raw analytical data is provided in Attachment D. 5 Analysis 5.1 Calibration A 9-level calibration curve was analyzed at the beginning and throughout the analytical sequence for the compounds of interest. The calibration points were prepared at 0, 25, 50, 100, 250, 500, 1000, 2500, and 5000 ng/L (ppt) for LC/MS/MS analysis. The instrument response versus the concentration was plotted for each point. Using linear regression with 1/x weighting, the slope, y-intercept and correlation coefficient (r) and coefficient of determination (r2) were determined. A calibration curve is acceptable if r >.0.985 (r2 > 0.970). Calibration standards are prepared using the same SPE procedure used for samples. All calibration criteria were met for this analysis. 5.2 Blanks Extraction blanks were prepared and analyzed with every extraction batch of samples. The extraction blanks should not have any target analytes present at or above the concentration of the low-level calibration standard. For these samples, the extraction blanks were compliant. PAGE 3 OF5 Instalment blanks in the form of clean methanol solvent were also analyzed after every highlevel calibration standard, and after known high-level samples. Again, the blanks should not have any target analytes present at or above the low-level calibration standard. For the samples presented here the instrument blanks are compliant. 5.3 Surrogates Surrogate spikes are not a component of the LC/MS/MS analytical methods. 5.4 Matrix Spikes Field and laboratory spikes were prepared using all compounds of interest. Field spikes were prepared by adding a measured volume of field sample to a container spiked with the target analytes by the laboratory prior to shipping containers for sample collection. Laboratory spikes consisted of aliquots of un-spiked field samples that were fortified at the laboratory at the time of extraction. Field blank spikes consisted of laboratory water fortified at the laboratory and shipped with the sample containers to the field and back to the laboratory for analysis. Laboratory control spikes (see section 5.6) are samples of laboratory water spiked at the time of extraction. Each type of spike provides information needed to assess analyte stability, extraction efficiency, and matrix effects that may impact analytical results. Matrix spike recoveries are given in Attachment B. Please see Section 5.7 for additional discussion of matrix spike recoveries. 5.5 Duplicates Field and laboratory duplicates were prepared for each field sample. Duplicate results are given along with the sample results in Attachment A. 5.6 Laboratory Control Samples For LC/MS/MS analyses, Milliq water was spiked with all compounds of interest at 100 and 500 ng/mL during each extraction set. All recoveries for all compounds were between 70 130% in each LCS. Results are given along with the raw data in Attachment D. 5.7 Statement of Accuracy Based on results of field blank spikes and laboratory control spikes, the analytical method accuracy for all analytes is 30%. Based on the results of field matrix spike samples, the overall accuracy for the analysis is as follows: C6 Acid and C7 Acid 40% C5 Acid, C4 Sulfonate, and FBSA 50% All others 30% All spike recovery data are reported in the data tables. In some cases, laboratory matrix spikes showed high and variable recoveries. Results were confirmed by re-extraction and reanalysis. In these cases, the field matrix spike was used for calculation of accuracy statements. PAGE 4 OF 5 5.8 Data Summary Please see Attachment A for a detailed listing of the analytical results. Results are reported in parts per billion (ppb) (ng/mL). Please note that the limit of quantitation is 1.0 ng/mL for all compounds except MeFBSE-OH and C4 Acid, which have a quantitation limit of 4.0 ng/mL. 6 Data/Sample Retention Samples are disposed of one month after the report is issued unless otherwise specified. All electronic data is archived on retrievable media and hard copy reports are stored in data folders maintained by Exygen. 7 Attachments 7.1 Attachment A: Results 7.2 Attachment B: Matrix Spike Recoveries 8.3 Attachment C: Chain of Custody 8.4 Attachment D: Raw Analytical Data Other Lab Members Contributing to Data Chrissy Edwards PAGE 5 OF 5 Section A Proven Results. Recovery Summary of Fluorochemical Residues in Outfall 001 Effluent for E06-0366 Sample Description Outfall 001 Effluent Low Fiald Spika Outfall 001 Effluent High Fiald Spiks C4 Acid* C5 Acid C6 Acid C7 Acid Amount Amt Found Amount Amt Found Amount Amt Found Amount Amt Found Amount Spiked in Sample Recovered Recovery in Sample Recovered Recovery in Sample Recovered Recovery in Sample Recovered Recovery (ng/mL) (ng/mL) (ng/mL) <%) (ng/mL) (ng/mL)____ (%) (ng/mL) (ng/mL) (%) (ng/mL) (ng/mL) (%) 10 12.1 , 19.3 72 ND 5.64 56 2.48 8.53 61 1.34 7.68 63 100 12.1 76.5 64 ND 45.0 45 2.48 60.5 58 1.34 54.4 53 O utfall 001 Effluant Spk C Low Lab Spika 12.1 18,5 ** ND 2.36 236 2.48 3.34 86 1.34 2.59 125 O utfall 001 Effluant Spk D High Lab Spika Field Blank Low Fiald Spika Field Blank High Fiald Spika 100 10 100 12.1 ND ND 729 717 12.6 126 125 125 ND ND ND 144 144 2.48 168 166 1.34 218 217 12.2 122 ND 11.1 111 ND 11.7 117 113 113 ND 116 116 ND 126 126 Sample Description Outfall 001 Effluent Low Fiald Spika Outfall 001 Effluent High Fiald Spika O utfall 001 Effluant S pkC Low Lab Spika O utfall 001 Effluant Spk D High Lab Spika Field Blank Low Fiald Spika Field Blank High Fiald Spika C8 Acid C9 Acid C 1 0 Acid C11 Acid Amount Amt Found Amount Amt Found Amount Amt Found Amount Amt Found Amount Spiked in Sample Recovered Recovery in Sample Recovered Recovery in Sample Recovered Recovery in Sample Recovered Recovery (ng/mL) (ng/mL) (ng/mL) (%) (ng/mL) (ng/mL) (%> (ng/mL) (ng/mL)____ (%) (ng/mL) (ng/mL)____ (%) 10 2.45 12.0 96 ND 6.86 69 ND 6.95 70 ND 6.59 66 100 2.45 110 108 ND 60.7 61 ND 69.7 70 ND 67.0 67 1 2.45 3.22 77 ND 1:80 160 ND 1.43 143 ND 1.48 148 100 2.45 129 127 ND 200 200 ND 174 174 ND 182 182 10 ND 11.8 118 ND 10.3 103 ND 11.2 112 ND 12.9 129 100 ND 129 129 ND 115 115 ND 107 107 ND 124 124 ND = Not detected = Response between 0 and 1 ng/mL. ND = Not detected = Response between 0 and 4 ng/mL. "Sample residue exceeded the spiking level by more than 4 times; therefore an accurate recovery cannot be calculated. 0006 ,^k3.03055f8 Research Drive * m s tSatatte College, PA 16801 V,T: 814.272.1039 F: 814.231.1580 exygen.com USA Proven Results. Recovery Summary of Fluorochemical Residues in Outfall 001 Effluent for E06-0366 Continued Sample Description Outfall 001 Effluent Low FlaldSpIka Outfall 001 Effluent High Field Spike C12 Acid C4 Sulfonate C6 Sulfonate CS Sulfonate Amount Amt pound Amount Amt Found Amount Amt Found Amount Amt Found Amount Spiked in Sample Recovered Recovery in Sample Recovered Recovery in Sample Recovered Recovery in Sample Recovered Recovery (ng/mL) (ng/mL.) (ng/mL) (V.) (ng/mL) (ng/mL) (/.) (ng/mL) (ng/mL)____ (%) (ng/mL) (nfl'mL)____ (%) 10 ND 5.46 55 13.0 16.8 38 ND 12.5 125 7.82 19.2 114 100 ND 65.8 66 13.0 92.7 80 ND 126 126 7.82 137 129 Outfall 001 Effluent Spk C Low Lab Spike 1 ND 1.76 176 13.0 9.86 - ND 1.55 155 7.82 8.51 ** Outfall 001 Effluent Spk D High Lab Spike 100 ND 216 216 13.0 83.9 71 ND 115 115 7.82 123 115 Field Blank Low Field Spike 10 ND 12.8 t0o0 ND 11.6 116 ND 11.2 112 ND 10.3 103 Field Blank High Field Spike 100 ND 129 129 ND 112 112 ND 98.7 99 ND 93.9 94 Sample Description Outfall 001 Effluent Low Fiald Splka Outfall 001 Effluent High Field Spike O utfall 001 Effluent Spk C Low Lab Spike O utfall 001 Effluent Spk D High Lab Spike Field Blank Low Field Spike Field Blank High Field Spike FBSA FOSA Me-FBSE-OH* Amount Amt Found Amount Amt Found Amount Amt Found Amount Spiked in Sample Recovered Recovery in Sample Recovered Recovery in Sample Recovered Recovery (ng/mL) (ng/mL) (ng/mL) (*/.) (ng/mL) (ng/mL) (%) (ng/mL) (ng/mL) (%) 10 17.5 22.2 47 ND 10.5 105 20.7 33.7 130 100 17.5 149 132 ND 139 139 20.7 153 132 1 17.5 17.3 " ND L73 173 20.7 18.4 " 100 17.5 141 124 ND 113 113 20.7 117 96 10 ND 11.1 111 ND 10.6 106 ND 11.3 113 100 ND 112 112 ND 102 102 ND 122 122 ND = Not detected = Response between 0 and 1 ng/mL. *ND = Not detected = Response between 0 and 4 ng/mL. "Sample residue exceeded the spiking level by more than 4 times; therefore an accurate recovery cannot be calculated. 0007 v,T^LW3s'30t0S5a5tatt8teRCeosleleagrceh, Drive PA 16801, USA VJ: 814.272.1039 F: 814.231.1580 exygen.com Section B Analytical ^ L Report 1 Summary of Fluorochemical Residues in Outfall 001 Effluent for E06-0366 Sample ID Outfall 001 Effluent Outfall 001 Effluent* Outfall 001 Effluent Dup Travel Blank Equipment Blank , C4 Acid** Perfluorobutyric Acid 12.1 11.9 12.4 ND ND Analyte Found (ng/mL) C5 Acid C6 Acid Perfluoropentanoic Acid Perfluorohexanolc Acid ND 2.48 ND 2.43 ND 2.51 ND ND ND ND C7 Acid Perfluoroheptanoic Acid 1.34 1.24 1.36 ND ND Sample ID Outfall 001 Effluent Outfall 001 Effluent* Outfall 001 Effluent Dup Travel Blank Equipment Blank Sample ID Outfall 001 Effluent Outfall 001 Effluent* Outfall 001 Effluent Dup Travel Blank Equipment Blank C8 Acid Perfluorooctanoic Acid 2.45 2.58 2.49 ND ND Analyte Found (ng/mL) C9 Acid C10 Acid Perfluorononanoic Acid Perfluorodecanoic Acid ND ND ND ND ND ND ND ND ND ND C11 Acid Perfluoroundecanoic Acid ND ND ND ND ND C12 Acid Perfluorododecanoic Acid ND ND ND ND ND Analyte Found (ng/mL) C4 Sulfonate C6 Sulfonate Perfluorobutanesulfonate Perfluorohexanesulfonate 13.0 ND 10.4 ND 10:2 ND ND ND ND ND C8 Sulfonate Perfluorooctanesulfonate 7.82 8.55 9.32 ND ND Analyte Found (ng/mL) Sample ID Outfall 001 Effluent Outfall 001 Effluent* Outfall 001 Effluent Dup Travel Blank Equipment Blank FBSA 17.5 16.7 17.3 ND ND FOSA ND 1.05 1:01 ND ND Me-FBSE-OH** 20.7 27.5 20.3 ND ND ND = Not detected = Response between 0 and 1 ng/mL. **ND = Not detected = Response between 0 and 4 ng/mL. 'Laboratory Duplicate 0008 J&303055L8 Research D rive V^ m s tSatatte College, PA 16801, USA T: 814.272.1039 F: 8 1 4 .2 3 1 .1 5 8 0 exygen.com Section G 3058 Research Drive State College, PA 16801 Phone: 814-272-1039 Fax: 814-231-1580 Loain Login Group: L0008988 Login #: Project: Company Name: Submitted By: 9099 P0000522 3M Kent Lindstrom Conform COC Sample: Conform COC: Conform Sample: Conform Request: True True True True Login Type: Immediate Receipt of Samples Started: True Date Start: 07/02/2006 Due Date: 07/12/2006 Login Initiated*: 07/02/2006 Dates entered into "Login Initiated" field prior to 1/5/06 reflect dates of receipt. The field was formerly called "Received Date" Received By: Edwards, Eric Spread Sample: Label: Exygen SD/PI: Risha, Karen Project Title/Type: Groundwater Sampling, Decatur AL/RO UTINE Login Notes: Packaae PK0010594 Carton Packages / Containers Date / Condition ShiDDer/ ID Received Date: 6/29/06 10:07 Package & Contents Uncompromised FEDEX 8578 5275 5418 Temo. Control/TemD. None 19.3 Direction / Handled Bv RECEIVED Edwards, Eric Container # C0195780 C0195781 C0195782 C0195783 C0195784 C0195785 C0195786 C0195787 Gross Weiaht dH Container TvDe 600.90 g 500 ml Clear Plastic Narrow 603.60 g 500 ml Clear Plastic Narrow 261.68 g 500 ml Clear Plastic Narrow 244.42 g 500 ml Clear Plastic Narrow 259.21 g 500 ml Clear Plastic Narrow 256.21 g 500 ml Clear Plastic Narrow 255.67 g 500 ml Clear Plastic Narrow 613.10 g 500 ml Clear Plastic Narrow Preservative NONE NONE NONE NONE NONE NONE NONE NONE Mfa. Lot Mfa. ID 7/2/2006 Login.rpt 0009 Report Version: Jun 9 2006 12:21PM Page 1 of 2 Instance: R0265826 R0265826 SamDle ID L0008988-0001 L0008988-0002 L0008988-0003 L0008988-0004 L0008988-0005 L0008988-0006 L0008988-0007 L0008988-0008 Container C0195780 C0195781 C0195782 C0195783 C0195784 C0195785 C0195786 C0195787 Matrix LIQUID LIQUID LIQUID LIQUID LIQUID LIQUID LIQUID LIQUID Login Fraction Water Samples Sample Outfall 001 Effluent Water Outfall 001 Effluent Dup Water Outfall 001 Effluent 10 PPB Low Spike Water Outfall 001 Effluent 100 PPB High Spike Water Field Control/Travel Blank Water Field Control/Travel Blank Low Spike Water Field Control/Travel Blank High Spike Water Equipment Blank Date SamDled 06/28/2006 06/28/2006 06/28/2006 06/28/2006 06/28/2006 06/28/2006 06/28/2006 06/27/2006 Date Due 07/12/2006 07/12/2006 07/12/2006 07/12/2006 07/12/2006 07/12/2006 07/12/2006 07/12/2006 7^ 1777Login Reviewed By: Date/Time: y7- T ' ' za^ ' 7/2/`106 Lo9in.-pt 0010 Report Version: Jun 9 2006 12:21PM Page 2 of 2 Instance: R0265826 R0265826 race A nalytical /Section A Address Email To: Section B Required Project Information: ReportW V . K 4 - U Copy To: Purchase Order No.: CHAIN-OF-CUSTODY / Analytical Request Document The Chain-of-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. sU Section C Invoice Information: Attention: Company Name: Address: Pace Quote Reference: Page: j of J 0980247 REGULATORY AGENCY NPDES GROUND WATER DRINKING WATER UST RCRA ^Cbther ---------------------------------------------------------------------. SITE LOCATION GA DIL GIN noH nsc nwi ALGMI GMN GNC j?K)THER ! I Phone Fax Requested Due Date/TAT: Secti.on D Required Client Information SAMPLE ID One Character per box. (A-Z, 0-9 /.-) Samples IDs MUST BE UNIQUE Pace Project Manager: O m ^ A v L L O O l FCIAAm .CFW P t " 6" Valid Matrix Codes MATR|* CODE DRINKING WATER DW WATER WT WASTE WATER WW PRODUCT P SOIL/SOLID SL OIL OL WIPE WP AIR AR OTHER OT TISSUE TS O fe -D 3 C ,(d Pace Profile #: ClO h- II ujO COLLECTED COMPOSITE START COMPOSITE END/GRAB o T IM Ecr sg PS LU U- Z < o o A-t .t- Xr-(>3fc(,-OOl y r C 10 3 t OuV L 2D Vu O i LL Oh ^ 9 1 / [TU j i E 1 0 f an k t jrfasitL ofa-<>3fci,- Z w r * wr wr tcCirOCiiL id f pfe- 3 a >0( t*4- -I 1 ijjH i u - t o 6 / - <l J i i* . wr wr I o3i fv-*l '(Ae / - -o /O fc , /0 ? / /3 / /Q 3 > `'A e /o u ia l4 J c 11a tSfCf - o D 8 wr Preservatives Additional Comments: E'-f/'. J Z t ib + L - Chfinr^t. {4 b O. (? i P /T . F i a J C irfern* ? /x /> . c h lo rtA A Cc^~p o .0 4 ^ SEE REVERSE SIDE FOR INSTRUCTIONS ORIGINAL RELINQUISHED BY / AFFILIATION DATE TIME I mo ACCEPTED BY / AFFILIATION | DATE I TIME (d m f i r ? SAMPLE CONDITION z ? SAMPLER NAME AND SIGNATURE PRINT Name of SAMPL1EERR:: f ] / i nJ e r s t SIGNATURE of SAMPI yt&Ljfcfc DATE Signed (MIW/ DD / YY) 6 / y h (=> z zl zl >- ? (OD --o c Q: o ALLQ020rev.3,31 Mar05 Instructions for completing Chain of Custody (COC) 1. Section A and B: Complete all Client information at top of sheet: company name, address, phone, fax, contact (the person to contact if there are questions, and who will receive the final report.), e-mail address (if available), PO#. Project Name and/or Project Number as you would like to see it appear on the report. . 2. Section C: Invoice Information: Billing information is included in this section. This information should include the name and address of the person receiving the invoice. 3. Quote Reference should be completed if a quotation was provided by Pace Analytical. The Project Manager, and Profile No. will be completed by Pace Analytical Services. 4 Site Location: A separate COC must be filled out for each day of sample collection. Record the two letter postal code for the US state in which the samples were collected. 5. Regulatory Agency: List the program that is guiding the work to ensure proper regulations are followed. 6. Section D: Complete a Sample Description in the "SAMPLE ID' section as you would like it to appear on the laboratory report. The following information should also be included: the sample matrix, sample type (G (grab) or C (cOtnposite). When collecting a composite, the start time and end time should be documented in the respective boxes. The collection time for a grab (G) sample should be entered in the boxes marked `Composite End/Grab'), Sample temp at collection (if required by state), the total number of containers, and preservative used. 7. Mark if the sample was filtered in the field by marking Y or N in `Filtered' row by the Analysis requested. . 8. Requested Analysis: List the required analysis and methods on the lines provided and place a check in the column for the samples requiring the analysis. Additional comments should be referenced in the bottom left hand comer or include attachments for extended lists of parameters. 9. The sampler should print their name in the space provided and sign their name followed by the date of the sampling event at the bottom of the COC in the spaces designated for `SAMPLER NAME AND SIGNATURE', . . ,. - 10. When relinquishing custody of the samples to a representative of the laboratory or other organization, indicate the Item Numbers of those samples being transferred; sign relinquished by, date and time, and include your affiliation. ^Important Note: Standard Turnaround Time is 2 Weeks/10 business days. Results will be delivered by end of business on the date due unless other arrangements have been made with your project manager. t Special Project Requirements such as Low Level Detection Limits or level of QC reported must be included on the chain of custody in the Additional . Comments section. weAnalytical' /Section A ' Required Client Information: " """"' S Address mo t is s Email To: CHAIN-OF-CUSTODY / Analytical Request Document The Chain-of-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. Section B Required Project Information: Report To: ,. I/W . K f n T Copy To: L ttn a s T ro m Purchase Order No.: Section C Invoice Information: Attention: __________________________________ ^ Company Name: L. Address: Pace Quote Reference: NPDES UST Page: j of \ 0980247 REGULATORY AGENCY GROUND WATER DRINKING WATER RCRA j^O ther SITE LOCATION GA D IL noH n s c D IN nw i G M I MN NC " j/K > t h e r / U A B f r r i Phone Fax Requested Due Date/TAT: Section D Required Client Information SAMPLE ID One Character per box. 5IU (A-Z, 0-9 /.-) Samples IDs MUST BE UNIQUE Project Name: P C o rk i/t, Project Number: /A A Valid Matrix Codes MATRIX CODE DRINKING WATER DW WATER WT WASTE WATER WW PRODUCT P SOIL/SOLID SL OIL OL WIPE WP AIR AR OTHER OT TISSUE TS r Pace Project Manager: o o i F cm n .(5 t , ,/ O (o -D 3 C s L > Pace Profile #: So & COLLECTED I COMPOSITE START COMPOSITE END/GRAB vr C CfTIME DATE 1031 TIME /o3) rC, / 031 ^ h o /Oi ! fcA /*>-*) I ) \ / P re s e rv a tiv e s Jo3l /O h ! ^ 8 /oc. ^/v/oc. P Additional Comments: F - ff . f r\*JI c h i DYiret irvg SEE REVERSE SIDE FOR INSTRUCTIONS ^ _ iL _ 2 t/^ O .o u ) *?! mM I RELINQUISHED BY / AFFIL ATION - r /PfitZ. u --p M DATE H IIIH T IM E ACCEPTED BY / AFFIL ATION HZQ 11 DATE TIME SAM PLE CONDITION k 'k /C(7 ? z z? z? tr- z>-l z? z? z? X z? z? Z?1 _zL_i_ Temp in C Received on Ice Custody Sealed Cooler Samples Intact SAMPLER NAME AND SIGNATURE PRINT Name of SAMPLER: x SIGNATURE of SAMPLER: f f (V "7 T // s u J nift__________________________ A/ DATESigneji (MNW DD/YY) > io G ALLQ020rev.3,31 Mar05 Instructions for completing Chain of Custody (COC) C- 1 .-Section A and B: Complete all Client information at top of sheet: company name, address, phone, fax, contact (the person to contact if there are ` questions, and who will receive the final report. ), e-mail address (if available), PO#, Project Name and/or Project Number as you would like to see it appear on the report. r ;" 2. Section C: Invoice Information: Billing information is included in this section. This information should include the name and address of the person receiving the invoice. 3. Quote Reference should be eompleted if a quotation was provided by Pace Analytical. lTie Project Manager, and Profile No. will be completed by Pace Analytical Services. -'A - . .. 4. Site Location: A separate COC must be filled out for each day of sample collection. Record the two letter postal code for the US state in which the sampleswere collected. 5. Regulatory Agency: List the program that is guiding the work to ensure proper regulations are followed. 6. Section D: Complete a Sample Description in the ' SAMPLE ID' section as you would like it to appear on the laboratory report. The following information should also be included: the sample matrix, sample type (G (grab) orC (composite). When collecting a composite, the start time and end time should be documented in the respective boxes. The collection time for a grab (G) sample should be entered in the boxes marked "Composite Lnd/Gralv ). Sample temp at collection (if required by state), the total number of containers, and preservative used. i 7. Mark if the sample was filtered in the field by marking Y or N in Filtered' row by the Analysis requested*., 8. Requested Analysis: fist the required analysis and methods on the lines provided and place a check in-the -column for the samples requiring the analysis. Additional comments should be referenced in the bottom left hand comer or include attachments for extended lists of parameters. - 9. The sampler should print their name in the space provided and sign their name followed by the date of thesampling event at the bottom of the COC in the spaces designated for `SAMPLER NAME AND SIGNATURE'. '. . ; 10. When relinquishing custody of the samples to a representative of the laboratory or other organization, indicate the Item Numbers of those samples being transferred; sign relinquished by, date and time, and include your affiliation. ^Important Note: Standard Turnaround Time is 2 Weeks/10 business days. Results will be delivered by .end of business on the date due unless other arrangements have been made with your project manager. . Special Project Requirements such as Low Level Detection Limits or level of QC reported must be included on the chain of custody in the Additional Comments section. ' aceAnalytical /Section A ' Required Client Information: ^ "3 Address m CT is s Email To: CHAIN-OF-CUSTODY / Analytical Request Document The Chain-of-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. Section B Required Project Information: Report To: . ,. i/ W . K ? / ) t L it e r ! .T ro r'n Copy To: Section C Invoice Information: Attention: Company Name: Address: Purchase Order No.: Pace Quote Reference: Page: j of \ 0980247 REGULATORY AGENCY NPDES GROUND WATER DRINKING WATER ,, UST RCRA J^Other SITE LOCATION GA OIL GIN noH n sc nw i D M I MN GNC ?It h e r / U A B r t - ' rt Phone Fax Project Name: Requested Due Date/TAT: Project Number: / m Valid Matrix Codes Section D Required Client Information MATRIX CODE DRINKING WATER DW SAMPLE ID WATER WASTE WATER PRODUCT WT WW P 1 SOIL/SOLID SL One Character per box. OIL OL (A-Z, 0-9 /.-) WIPE AIR WP AR Samples IDs MUST BE UNIQUE OTHER OT TISSUE TS . . Pace Project Manager: O O l F cfyW n .Q n? ^ . _1 / / O d - o 3<o U Pace Profile #: uQj.=O 5 u 8 COLLECTED 8 COMPOSITE START COMPOSITE END/GRAB fcc r DATE TIME 1 O u T - f A i- W OOJ W r lou | 0 3 V > I C lu j Urt,'UL' fftp __Da up t Ot, a i J _5G CX. h H L iL j j x u Tr (C _( crr*\fg Ml 0$WrH3 ir r o -tU> wf o)p-9$U, x>^ 1 % wr & h T c -a Stir w -i tF M o Lj 4l,i - 03 > >oL UT * -4 J i ><- tut 6/6 ?/OQ I o 3 j k tk t L . /o 3 / /0 3/ /2 0 /.. `'A g/oc. ^hlO U IL m lZ,A V Jr o t Sifiit ODS wr yo^i g Oo X J? Preservatives Additional Comments: } Z i f . TnthfitiXTM inici jftb r / T . Ti*Jl 0. 0, 1 0 f i f . ChloYiX'-i 0 , 0 t-j SEE REVERSE SIDE FOR INSTRUCTIONS 3 y l? fl RELIN Q U ISH ED BY / A FFILIA TIO N DATE TIM E A ? 3t> w ACC EPTED BY / A FFILIA TIO N DATE Mi TIM E f c ( ' S A M PLE CONDITION Z ? z ? z ? c zl ? z ? z ? z ? z* ? z ? k z > z Received on Ice Custody Sealed Cooler Samples Intact S A M PLER NAM E AN D SIGNATURE PRINT Name of SAMPLER: /" ) // * x. SIGNATURE of SAMPLER: f ri ft T f A i ____ J b f c x : ------------ DATE Signed (M M / DD / YY) W ^ s /o G 0u _ a E 1 ALLQ020rev.3,31 Mar05 Instructions for completing Chain of Custody (COC) ,1.. -Section A and B: Complete all Client information at top of sheet: company name, address, phone, fax, contact (the person to contact if there are questions, and who will receive the final report.), e-mail address (if available), PC)#. Project Name and/or Project Number as you would like to see it appear on the report. ... ;i 2. Section C: Invoice Information: Billing information is included in this section. This information should include the name and address of the person receiving the invoice. 3. Quote Reference should be completed if a quotation was provided by Pace Analytical. The Project Manager, and Profile No. will be completed by Pace Analytical Services. !' 4. ;Site Location: A separate COC must be filled out for each day of sample collection. Record the two letter postal code for the US state in which the samples were collected. 5. Regulatory Agency: f ist the program that is guiding the work to ensure proper regulations are followed. 6. Section D: Complete a Sample Description in the "SAMPLE ID' section as you would like it to appear on the laboratory report. The following information should also be included: the sample matrix, sample type (G (grab) or C (composite). When collecting a composite, the start time and end time should be documented in the respective boxes. The collection time for a grab (G) sample should be entered in the boxes marked 'Composite Tnd/Grab'), Sample temp at collection (if required by state), the total number of containers, and preservative used. `: 7. Mark if the sample was filtered in the field by marking Y or N in `Filtered' row by the Analysis requested. 8. Requested Analysis: List the required analysis, and methods on the lines provided and place a check in the column for the samples requiring the analysis. Additional comments should be referenced in the bottom left hand comer or include attachments for extended lists of parameters. 9. The sampler should print their name in the space provided and sign their name followed by the date of the sampling event at the bottom of the COC in the spaces designated for `SAMPLER NAME AND SIGNATURE'. ,, , , ,_ 10. When relinquishing custody of the samples to a representative of the laboratory or other organization, indicate the Item Numbers of those samples being transferred; sign relinquished by, date and time, and include your affiliation. Important Note: Standard Turnaround Time is 2 Weeks/10 business days. Results will be delivered by end of business on the date due unless other arrangements have been made with your project manager. Special Project Requirements such as Low Level Detection Limits or level of QC reported must be included on the chain of custody in the Additional Comments section. ' aceAnalytical /Section A ' R equired Client Information: " """"' S Address m et 4 ss Email To: Phone Fax Requested Due Date/TAT: CHAIN-OF-CUSTODY / Analytical Request Document The Chain-of-Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately. Section B R equired Project Information: Report To: . ,. i/y v . K f 'to T t-u o d c ,W o * ^ Copy To: ' Section C Invoice Information: Attention: Company Name: Address: Purchase Order No.: Pace Quote Reference: Project Name: t> c r$ 4 u A , /A rt . , Pace Project Manager: o o i F c fl4 o n . fi' e o G -o s tc , Pace Profile #: Page: ) of \ 0980247 REGULATORY AGENCY NPDES GROUND WATER DRINKING WATER . UST RCRA brother SITE LOCATION GA G IL G IN nOH G SC GW I GM I MN QNC C^STHER / U A B A ' - ' rt Additional Comments: F4f. T ,,r r ( ( . f 1# ' r U . ch tn- ( o . p SEE REVERSE SIDE FOR INSTRUCTIONS b 0 i & RELINQUISHED B Y /A FFILIA TIO N DATE TIME J2M I-- -- 1 1 1 -- M i l l iAACCCCEEPPTTED BY / AFFILIATION DATE [ TIME t- MPLE CONDITION z? z I. Z? O o "1it 4 SAMPLER NAME AND SIGNATURE - ! *PRINT Name o f SAMPLER: } tJ ' _____ X of SAMPLER: A J A I ------- ____ V ------------------ -- DATE Signed (M M /D D /Y Y ) > 7 -3 g fo 6 CoDC--co >> O "5 "o Eo cwo* ALLQ020rev.3,31 Mart)5 Instructions for completing Chain of Custody (COC) 1. Section A and B: Complete all Client information at top of sheet: company name, address, phone, fax. contact (the person to contact if there are questions, and who will receive the final report.), e-mail address (if available), PO#. Project Name and/or Project Number as you would like to see it appear on the report. 2. Section C: Invoice Information: Billing information is included in this section. This information should include the name and address of the person receiving the invoice. 3. Quote Reference should be completed if a quotation was prov ided by Pace Analytical. The Project Manager, and Profile No. will be completed by Pace Analytical Services. 4. Site Location: A separate COC must be filled out for each day of sample collection. Record the two letter postal code for the US state in which the samples were collected. 5. Regulatory Agency: List the program that is guiding the work to ensure proper regulations arc followed. 6. Section D: Complete a Sample Description in the "SAMPLE ID' section as you would like it to appear on the laboratory report. The following information should also be included: the sample matrix, sample type (G (grab) or C (composite). When collecting a composite, the start time and end time should be documented in the respective boxes. The collection time for a grab (G) sample should be entered in the boxes marked 'Composite End/Grab'), Sample temp at collection (if required by state), the total number of containers, and preservative used. 7. Mark if the sample was filtered in the field by marking Y or N in Filtered' row by the Analysis requested. 8. Requested Analysis: lis t the required analysis and methods on the lines provided and place a check in the column for the samples requiring the analysis. Additional comments should be referenced in the bottom left hand comer or include attachments for extended lists of parameters. 9. The sampler should print their name in the space provided and sign their name followed by the date of the sampling event at the bottom of the COC in the spaces designated for `SAMPLER NAME AND SIGNATURE'. ' 10. When relinquishing custody of the samples to a representative of the laboratory or other organization, indicate the item Numbers of those samples being transferred; sign relinquished by, date and time, and include your affiliation. Important Note: Standard Turnaround Time is 2 Weeks/10 business days. Results will be delivered by end of business on the date due unless other arrangements have been made with your project manager. Special Project Requirements such as Low Level Detection l imits or level of QC reported must be included on the chain of custody in the Additional Comments section. 6/12/2006 Project: E06-0366 3M ENVIRONMENTAL LABORATORY Preliminary/Unauthorized Report Page 1 of 4 Requester: Schnobrich, Dana M (223-1N-08) Department: 530711 Project Number: 0022674449 Date Received: 6/12/2006 Project Description: Decatur Outfall 001 FC Monitoring Quarterlj Comments: Completion Date: Project Lead: Kent Lindstrom Phone Number: 651-778-5352 Email Address: krlindstrom@mmm.com Statement o f Accuracy:_______________________________ Project Results/Activitv Pace Field Sampling Event 3M Sample Number_____ Sampled Date______Sample Description______________________________________________ E06-0366-001 6/27/2006 Outfall 001 Effluent - Composite LAB EXYGEN Analytical Method LCMS E06-0366-002 6/27/2006 Components PFOS PFHS PFBS FOSA PFBAmide MeFBSE-OH C4 acid C5 acid C6 acid C7 acid PFOA C9 acid CIO acid C ll acid C12 acid Result Outfall 001 Effluent - Composite Duplicate RL Qualifier LAB EXYGEN Analytical Method LCMS Components PFOS PFHS PFBS FOSA PFBAmide MeFBSE-OH C4 acid C5 acid C6 acid C7 acid PFOA C9 acid CIO acid C ll acid C12 acid Result RL Qualifier 0012 6/12/2006 3M ENVIRONMENTAL LABORATORY Preliminary/Unauthorized Report Page 2 of 4 Project: E06-0366 (cont.) 3M Sample Number_____ Sampled Date______Sample Description________________________ E06-0366-003 6/27/2006 Outfall 001 Effluent Comp -1 0 PPB Low Spike LAB EXYGEN Analytical Method LCMS E06-0366-004 6/27/2006 Components PFOS PFHS PFBS FOSA PFBAmide MeFBSE-OH C4 acid C5 acid C6 acid C7 acid PFOA C9 acid CIO acid C ll acid C12 acid Result Outfall 001 Effluent Comp -100 PPB High Spike RL Qualifier LAB EXYGEN Analytical Method LCMS E06-0366-005 6/27/2006 Components PFOS PFHS PFBS FOSA PFBAmide MeFBSE-OH C4 acid C5 acid C6 acid C7 acid PFOA C9 acid CIO acid C ll acid C12 acid Result RL Qualifier ___________________________________________________ Field Control/Travel Blank LAB EXYGEN Analytical Method LCMS Components PFOS PFHS PFBS FOSA PFBAmide MeFBSE-OH C4 acid C5 acid C6 acid C7 acid PFOA Result RL Qualifier 0013 6/12/2006 3M ENVIRONMENTAL LABORATORY Preliminary/Unauthorized Report Project: E06-0366 (cont.) 3M Sample Number Sampled Date______Sample Description___________ E06-0366-00S (cont.) 6/27/2006 Field Control/Travel Blank LAB EXYGEN Analytical Method LCMS (cont.) Components C9 acid CIO acid C ll acid C12 acid Result E06-0366-006 6/27/2006 Field Control/Travel Blank Low Spike LAB EXYGEN Analytical Method LCMS Components PFOS PFHS PFBS FOSA PFBAmide MeFBSE-OH C4 acid C5 acid C6 acid C7 acid PFOA C9 acid CIO acid C ll acid C12 acid Result E06-0366-007 6/27/2006 Field Control/Travel Blank High Spike LAB EXYGEN Analytical Method LCMS Components PFOS PFHS PFBS FOSA PFBAmide MeFBSE-OH C4 acid C5 acid C6 acid C7 acid PFOA C9 acid CIO acid C ll acid C12 acid Result E06-0366-008 6/27/2006 Equipment Blank LAB EXYGEN Analytical Method LCMS Components PFOS PFHS PFBS FOSA PFBAmide Result 0014 Page 3 of 4 RL Oualifier RL Oualifier RL Oualifier RL Oualifier 6/12/2006 3M ENVIRONMENTAL LABORATORY Preliminary/Unauthorized Report Project: E06-0366 (cont.) 3M Sample Number_____ Sampled Pate______Sample Description________________________________ E06-0366-008 (cont.) 6/27/2006 Equipment Blank LAB EXYGEN Analytical Method LCMS (cont.) Components MeFBSE-OH C4 acid C5 acid C6 acid C7 acid PFOA C9 acid CIO acid C ll acid C12 acid Result RL Page 4 of 4 Qualifier 0015 Sample.Sa Test.Test_ TestReplic Test.Analyi ResultNan Result.Res Result.Entr Result.Attri Result.Unit 98197 997314 1 LCMS WVPFOS N NG/ML 98197 997314 1 LCMS WVPFHS N NG/ML 98197 997314 1 LCMS WVPFBS N NG/ML 98197 997314 1 LCMS_WV FOSA N NG/ML 98197 997314 1 LCMS_WV PFBAmide N NG/ML 98197 997314 1 LCMS_WV MeFBSE-C N NG/ML 98197 997314 1 LCMS_WV C4 acid N NG/ML 98197 997314 1 LCMS_WV C5 acid N NG/ML 98197 997314 1 LCMS_WV C6 acid N NG/ML 98197 997314 1 LCMS WV C7 acid N NG/ML 98197 997314 1 LCMS_WV PFOA N NG/ML 98197 997314 1 LCMS_WV C9 acid N NG/ML 98197 997314 1 LCMS_WV C10 acid N NG/ML 98197 997314 1 LCMS_WV C11 acid N NG/ML 98197 997314 1 LCMS_WV C12 acid N NG/ML 98198 997315 1 LCMS_WV PFOS N NG/ML 98198 997315 1 LCMS_WV PFHS N NG/ML 98198 997315 1 LCMS_WV PFBS N NG/ML 98198 997315 1 LCMS VW FOSA N NG/ML 98198 997315 1 LCMS_VW PFBAmide N NG/ML 98198 997315 1 LCMS_WV MeFBSE- CN NG/ML 98198 997315 1 LCMS_WV C4 acid N NG/ML 98198 997315 1 LCMS_WV C5 acid N NG/ML 98198 997315 1 LCMS_WV C6 acid N NG/ML 98198 997315 1 LCMS_WV C7 acid N NG/ML 98198 997315 1 LCMS_WV PFOA N NG/ML 98198 997315 1 LCMS WV C9 acid N NG/ML 98198 997315 1 LCMS WVC10 acid N NG/ML 98198 997315 1 LCMS_WVC11 acid N NG/ML 98198 997315 1 LCMS_WVC12 acid N NG/ML 98199 997316 1 LCMS WVPFOS N NG/ML 98199 997316 1 LCMS_WV PFHS N NG/ML 98199 997316 1 LCMS_WV PFBS N NG/ML 98199 997316 1 LCMS_WV FOSA N NG /M L 98199 997316 1 LCMSJA/V PFBAmide N NG/ML 98199 997316 1 LCMS_WV MeFBSE-C N NG/ML 98199 997316 1 LCMS_WV C4 acid N NG/ML 98199 997316 1 LCMS_WV C5 acid N NG/ML 98199 997316 1 LCMS_VW C6 acid N NG/ML 98199 997316 1 LCMS_WV C7 acid N NG/ML 98199 997316 1 LCMS WV PFOA N NG/ML 98199 997316 1 LCMS_WV C9 acid N NG/ML 98199 997316 1 LCMS_VW C10 acid N NG/ML 98199 997316 1 LCMS_WV C11 acid N NG/ML 98199 997316 1 LCMS WVC12 acid N NG/ML 98200 997317 1 LCMS_WV PFOS N NG/ML 98200 997317 1 LCMS WVPFHS N NG/ML 98200 997317 1 LCMS_VW PFBS N NG/ML 98200 997317 1 LCMS_WV FOSA N NG/ML 98200 997317 1 LCMS_WV PFBAmide N NG/ML 98200 997317 1 LCMS_WV MeFBSE-C N NG/ML 0016 98200 98200 98200 98200 98200 98200 98200 98200 98200 98201 98201 98201 98201 98201 98201 98201 98201 98201 98201 98201 98201 98201 98201 98201 98202 98202 98202 98202 98202 98202 98202 98202 98202 98202 98202 98202 98202 98202 98202 98203 98203 98203 98203 98203 98203 98203 98203 98203 98203 98203 98203 98203 997317 997317 997317 997317 997317 997317 997317 997317 997317 997318 997318 997318 997318 997318 997318 997318 997318 997318 997318 997318 997318 997318 997318 997318 997319 997319 997319 997319 997319 997319 997319 997319 997319 997319 997319 997319 997319 997319 997319 997320 997320 997320 997320 997320 997320 997320 997320 997320 997320 997320 997320 997320 1 LCMS_WV C4 acid N 1 LCMS_WV C5 add N 1 LCMS WV C6 acid N 1 LCMS_WV C7 acid N 1 LCMS WVPFOA N 1 LCMS_WV C9 acid N 1 LCMS WV C10 add N 1 LCMS_WV C11 add N 1 LCMS WV C12 add N 1 LCMS WVPFOS N 1 LCMS_WV PFHS N 1 LCMS_WV PFBS N 1 LCMS_WV FOSA N 1 LCMS WV PFBAmide N 1 LCMS_WV MeFBSE-C N 1 LCMS_WV C4 add N 1 LCMS_WV C5 add N 1 LCMS_WV C6 add N 1 LCMS WV C7 add N 1 LCMS WVPFOA N 1 LCMS_WV C9 add N 1 LCMS_WV C10 add N 1 LCMS_WVC11 add N 1 LCMS WV C12 add N 1 LCMS_WV PFOS N 1 LCMS WV PFHS N 1 LCMS WV PFBS N 1 LCMS WV FOSA N 1 LCMS WV PFBAmide N 1 LCMS_WV MeFBSE-C N 1 LCMS_WV C4 acid N 1 LCMS WV C5 add N 1 LCMS_WV C6 acid N 1 LCMS_VW C7 acid N 1 LCMS WVPFOA N 1 LCMS WV C9 add N 1 LCMS W V C IO add N 1 LCMS WVC11 add N 1 LCMS_WVC12 add N 1 LCMS_WV PFOS N 1 LCMS_WV PFHS N 1 LCMS_WV PFBS N 1 LCMS_WV FOSA N 1 LCMS_WV PFBAmide N 1 LCMS_WV MeFBSE- CN 1 LCMS_VW C4 acid N 1 LCMS WV C5 acid N 1 LCMS WV C6 acid N 1 LCMS_VW C7 acid N 1 LCMS_WV PFOA N 1 LCMS_WV C9 add N 1 LCMS W V C IO add N 0017 NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML 98203 98203 98204 98204 98204 98204 98204 98204 98204 98204 98204 98204 98204 98204 98204 98204 98204 997320 997320 997321 997321 997321 997321 997321 997321 997321 997321 997321 997321 997321 997321 997321 997321 997321 1 LCMS_WV C11 acid N 1 LCMS WV C12 acid N 1 LCMS_WV PFOS N 1 LCMS_WV PFHS N 1 LCMS WVPFBS N 1 LCMS WV FOSA N 1 LCMS_WV PFBAmide N 1 LCMSJ/W MeFBSE-C N 1 LCMS_WV C4 acid N 1 LCMS_WV C5 acid N 1 LCMS_WV C6 acid N 1 LCMS_WV C7 acid N 1 LCMS_WV PFOA N 1 LCMS_WV C9 acid N 1 LCMS WVC10 acid N 1 LCMS WVC11 acid N 1 LCMS WV C12 acid N NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML NG/ML 0018 Result.Attri Result. Has Attributes 0019 0020 G02 3058 Research Drive Phone: 814-272-1039 State College, PA 16801 Fax: 814-231-1580 TEMPORARY SAMPLE STORAGE FORM To be completed during ExyLIMS Login Project #: _________ Login # : _____ / O f l n K _____ Initials / D ate:. One form to be completed for each package Date / Time Received:.-- ----- /Q 0 ~ 2 ~ Received B y :. Shipper: D C - Shipper Package ID: 7 1? C *-//% Temperature (deg C) / Thermometer ID :______ /? 3 V 1/ ^ Temperature Control M ethod:___fJ<?iW ______________________ Temporary Storage Location: fo rjrs 2____ Condition of sample(s): ---Good - Package and contents uncompromised ___ Fair - Package damaged / contents uncompromised ___Poor - Package and contents compromised Notes: LIBRARY ID: V0001402-3 0022 LABORATORY FORM r Fed7 US A irb ill t xpress ' 57 5E75 SHlfi EDG FedEv Rptrip--u--al vCo' *nrut 11 From Date I} Ser Je r's FedEx Account Number 17 T F ? 3 5 0 4 Sender's Name 7 B l-O V S Iz Company ? a.c e , f W v , L fl Cc\ S '^ v ' J n r S X / T C . Address ____ 1 3 o o K \ * c y City _ l 4 ' ' U y \ - W s v / \ W . _____ State A>Oz,p ^< ~ U /OO DeptyRoor/Suite/Room P?? 2 Your Internal Billing Reference 3 To Recipient's Name Company ^ Ti>lftv\ U y ^ 1 r v\ r i n h ^ Phone yoo Jk.X v i ,.J ., I 3n o Recipient's Address 3 ^8 We canno* tniiver tu PG boxes or PO ZIP codes. K C cc i)r> v h DepUHoor/Sutte/Room 4a Express Package Service Packages up to 150lbsJ * I v / r e d E x Priority Overnight I 1_ t L Next business run 5 enveieiionMonbriv FedEx Standard Overni^ FedEx First Overnight Earnest in vt I 3 delivery io ani ct n i ; Saturaav Deliver NGT avallaba- _ |-- FedEx 2Day i FedEx Express Saver 3 I j Second business day' TTiursday 2 0 i I Third business day* 1-- 1 shipments will be delivered on Mnrd.iy L Saturday Delivery NOT available. unless SATURDAY Delivery is selected 1~ FedEx Envelope rate not available Mcicci i chahyd. One-pound rate. -------- ^ *To most focabofts. 4b Express Freight Service _ i-- I FedEx 1Day Freight* / I j Nextbusinessaay** Friday 83_ i-- i FedEx 2Day Freight O I I Second business day. Thursday ' ' shipments will be delivered on Monday shipments will be deliveredTin Monday unless SATURDAY Delivery is selected unless SATURDAY D o livw y wtected. *Call tor Confirmation . ___. . Packages over 150 lbs. FedEx 3Day Freight Third business dav " Saturday delivery NOI available. 4 To most locations 5 Packaging 6 [ : FedEx Envelope* FedEx Pak* J3 [ FedEx Includes FedEx Smaii Pak, Box FedEx Unge Pak. and FedFx Sturdy Pak FedEx Tube 1 ^ V OOttther f\ ' Declared value kninSSU 6 Special Handling - Include FedExaddress in Section 3 , SATURDAY Delivery J i 1 Not available for FedEx Standard Overnight, FedFir First Overnight, FedEx F*m Save- orFedx3DayFreight. HOLD Weekday i at FedEx Location Net ivjilnblefor Fcdf.' r'r:if Overnight 31 HOLD Saturday at FedEx Location Available ONLY tor FedEx Priority Overnight anrt FedEx 2Day to select locations. D oe s this s h ip m e n t c o n ta in d a n g e ro u s good s? LyV. /V One box must be checked. ** I_1AsperdiicJ I : V0S I.....I Shipper's Dvd Shippe-sDr Ttion not required r IUi dH^tvlesa.? ^Dangerous goods Iincluding dry ich) r xjt be shipped in FedF. pack :__ Cargo A ircra ft Only 7 Payment Billto: Obtain R e a p .! _ Enter FedEx A c c t No. or CreditCard N a b e lo w .-----------] A c c t No. 2 3 Qj 4 Li 5Recipient Third Party CreditCard |_ J Cash/Chftck Address . ____ To 'eqiisst a pa'-ia g'1 tic hiele 31 a sc -c .` .c FedEx location, print FedEx address here. Citv 7 l4 - ,e s p f l zip H e t o \ L 8578 5275 5418 8 NEW Residential Delivery Signature Options r-- No Signature i f | L j R e q u ire d 1U Package t*. b '' . t ! outobtar'pr: ;-y ,........ ~. DirectSigit-t'ure _ . ---, imndmnieeccti Sipnatui t I Anyone a i t r " , 0 4 | | II no n-tr ' address mav I .-V-iivery ------- recipient'-.. Fee applies atane;;;M. forpelivt!.- R*v.Date8/D5>Part#1582811994-2Q05FodExPRINTED IN U.S.A SRY [sl SO O O