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No. 202980 <br /> SEVERN TRENT LABORATORIES CHAIN OF CUSTODY RECORDi, s, <br /> CUSTOMER INFORMATION PROJECT INFORMATION <br /> COMPAN �QOnLL / fNW63 <br /> SEND REPORTTQ--, a <br /> J,} BILLING INFORMATION �A/j, <br /> BILL TO �7 7 <br /> ADDRESS (�j ��Wa <br /> 0 Q� Q LAB JOB NO. <br /> PHO ( , �i E`L�� Z�i rl PHONE m <br /> FAX ` FAX PO NO <br /> SAMPLE SAMPLE SAMPLE <br /> SAMPLE NO SAMPLE DESCRIPTION DATE TIME MATRIX CONTAINER PRESERV REMARKS/PRECAUTIONS <br /> a L <br /> ,--3 ,-Z <br /> KVJ _S— - <br /> 0 <br /> w <br /> a <br /> Lu <br /> z <br /> U) <br /> SAMPLER SHIPMENT METHOD AIRBILL NO <br /> 3 <br /> o REQ IRED TURNAROUND" ❑SAME DAY ❑24 HOURS ❑48 HOURS ❑72 HOURS ❑5 DAYS ❑10 DAYS L7 ROUTINE ❑OTHER <br /> rz <br /> �A 24-1-1 <br /> 1 RE NQUIS ED BY DATE 2 RELINQUISHED BY DATE 3 RELINQUISHED BY DATE <br /> SIG 9T R <br /> SIGNATURE NATURE <br /> C 0 <br /> C)2 ��- � z�1 v <br /> o PRINT NAME/COMPANY TIME T NAMEICOMPANY TIME <br /> P IN EDN MEICO PANT1% <br /> Q 1 RECEIVED BY DATE 2 RECEIVED BY DACE 3 RECEIVED BY DATE <br /> F SIGN UR SIGNATURE <br /> f Z/ G N SIGNATURE` <br /> U) r = <br /> cr PR NTEfl N}jjs±l£ICOM NY T E P D Ngo)COMPAN TI EI Ile �G PRINTED NAME! OMP NY �'� T r <br /> o Cj <br /> SEVER TRENT LABORATORIES l <br /> 1721 Strand Avenue • <br /> Sant CA 92705 c> <br />