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7ainCof <br /> dy Record Sev rn Trent Laboratories, Inc. <br /> STL4124 (0700) <br /> � 1 ri1 - vl� <br /> Client � Project Man Date7 ,/6' Chan of Custody Number <br /> Cay ! 6I 02550-9 <br /> Addres � lephone Number(Area Code)/Fax Number Lab Number <br /> a r q 0 Page of 47=_ <br /> rL <br /> State zip Coe rte Contact Lab Contact Analysis(Attach list if ux <br /> S more space is needed <br /> Project Name anq Locat n(State) CarnerlWayb+1!Number <br /> U J Special Instructions/ <br /> ContracUPurchasa Order/Quote No Containers& yj Conditions of Receipt <br /> j { 3 D 600 <br /> 6 Matrix Preservatives i1 <br /> Sample t D No and Des/cription Date UT <br /> o q ° z o =o <br /> (Containers for each sample may be combined on one line) a y x t z z N z <br /> Sf q <br /> Ww- a <br /> i <br /> rbie Hazard Identification Sample Disposal <br /> (A lea may be assessed if samples are retained <br /> zzHazard ❑ Flammable ❑ Skin Mont ❑Poison B ❑ Unknown ❑ Return To Client Disposal By Lab ❑Archive For Months longer than 3 months) <br /> Tum Around Time Required QC Requirements(Specify) <br /> ❑ 24 Hours ❑ 8 Hours ❑ 7 Days ❑ 14 Days ❑ 21 Days ❑ Other <br /> 1 Relinquished By Date Time I Received By Dat Time <br /> Z��o, Its 5 t6 f Z3s <br /> 2 Relinquished 8y Date Time 2 Received By Dae Time <br /> 3 Relinquished By Date Time 3 Received 8y Data Time <br /> Comments <br /> Am _ — <br /> DWRIBUT10AW41TE Stays with the Sample CANARY-Returned to Chent with Report PINK Field Copy <br />