Mid-Atlantic Environmental Laboratories, Inc.
Bottle Order Request
No.
Date of Request: Time of Request:
Client:
Person making request:
Phone Number: Date bottles are required:
Location of bottle drop off:
Sample Matrix: Groundwater Soil Wastewater Stormwater Drinking Water Other (specify)
Analysis/analyses to be performed:
State where sample will be collected: NJ PA DE MD Other (specify)
Project Name: Regulatory Program:
Number and size of bottle requested:
Quantity Preservative Quantity Preservative
5 g EnCore 60 ml plastic
1 liter amber glass w/TLC 250 ml plastic
32 oz wide-mouth glass w/TLC 500 ml plastic
4 oz. plastic cup 1000 ml plastic
40 ml vial 2 oz glass jar w/TLC
40 ml vial 4 oz glass jar w/TLC
40 ml vial – Field Blank 8 oz glass jar w/TLC
40 ml vial – Trip Blank 16 oz glass jar w/TLC
VOA vial foam sleeve please return foam sleeves to lab
Rinse water: Yes No Quantity: Liter Gallon
Additional information:
Bottle labels provided with bottle request. Chain of Custody available online; hardcopy available upon request.
Extra sample bottles (if included) are for sample duplicates and/or matrix spikes. These are essential elements of MAEL’s QA/QC program, and required by most regulatory authorities. Please provide extra sample when possible. Thank You!
Please return unused bottles!
Bottles prepared by: _________________________________________________ Date: _______________________
Bottles delivered by: _________________________________________________ Date: _______________________
Bottles received by: _________________________________________________ Date: _______________________
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