Acid Sulfate Management Plan · MCU16/0103

‘ourca: MFP_M630_SR.10132016231756. pif papa: 12 SGS Rat BEO1S333_COC

Revision #: 1

 

Request for Laboratory Services and Chain of Custody Form

LIMS No:

 

 

 

 

 

 

 

 

 

 

 

 

FPE
Laboretpey Geawon

Receved date: 12> 1O- 1G Recsvedby Ad+ GIG — cooing Method: BL Cant Cone Samplesiniact, Kee Oe

Logged-in Date: Time of Receipt je Cooler Sealed © Ks Che Cm Temperature: Clone (Oybat
COD must pay via cheque or credit card before analysis is commenced, AMEX & DINERS cards incur a §% surcharge

Name: Kaine Pritchard —
g [Company Future-Plus Environmental ape tea pwaerarey as De Do
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wy Address: PO Box 1250 Buddina, Q 4575 Replacement Sample Containers Required: Des Do
Q Results Required By: 4Days Urgent TA requires lab approval
= email: kanep@luture-pius com au Neer

Phone; 53579169 Fax:

[Client information PO No.: 1250, Buddina Q 4575 Project No.: 4956

 

 

‘Company Name:

Future-Plus Environmental

 

 

Contact Name:

Kaine Pritchard

 

|Addre

 

4/40 Technology Drive, WARANA

 

iPhone Number:

After Hours Phone Number:

 

 

 

 

 

 

 

 

 

 

 

 

6 ace. OS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fax Number: Email: kainep@future-plus com al
Note: Results will be sent via email to an unlimited number of addresses for no additional fee. In the absence of email, fax is available upon request.
Indicate results format (please check one): Email Fax 0
SAMPLE INFORMATION
Analysis Requested
£
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Date Sol | tof | 8 Qo CL el
€ s + )
é Sample Identifier sampied | T™ | water |potties| 3 {
2 Other Be /
4 2a
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}4956-161011-GW1 11/10/2016 w 4 x
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Renshied 49 Met — on
Sampled By: Kaine Pritchard Date: 11/10/2016

 

 

 

Relinquished By:

KP.

Date: 11/10/2016 Time:

 

4:00pm

 



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