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Chain of STL <br /> Custody Record �ftSopwlpvo <br /> JZrn Trent Laboratories, <br /> Inc. <br /> 3TL4124 (09011 <br /> Client �[J Project Ma er Date Chain of C uslodv Number <br /> �Y� 5 7 -4Lew 14-U.1'of <br /> Address Telephone Numler(Area CodepFax Number <br /> -Zr a kA-� �� g <br /> *J '3ti/-7y p y`— 33-orI 1 IOi 1p Page { of r <br /> Ci State zip Code Site Contact LalaCwareeF Analysis(Attach list if <br /> /Isrne— (`.f"ln '7z6/1f J.Q�,tm mares acersneeded <br /> Project Name and Location(State) <br /> IS&2 N IF f"dA t Speciallnstruchons/ <br /> Contract/Purchase Order/Quote No <br /> Containers& ; Conditions of Receipt <br /> Matrix <br /> l�' S Of'e sltG�Ins ��6 T1QL,f'6 Preservativesnesereservatrves <br /> x' o <br /> Sample!D No and Descrrptlon �Dale E 3 w o n � <br /> Time b a y a o o Z Vol(Containers for each Sample may be combined On one trite) ¢ i 0 on j Y x T 2 N 2 <br /> r /YL w- 10-t 1135I I Iv I he <br /> /%W 2- 11 <br /> MIM--(3 1117- <br /> 1 <br /> i � Mani-I� j�Lv <br /> APRI <br /> Possible/ Hazard tdentilicatr°h Sample Disposal <br /> Non Hazard ❑Flammable (A tee may be assessed it samples are retained <br /> LV <br /> ❑ Skin Irritant ❑ Parson B ❑ Unknown ❑ Return To Client ❑Disposal By Lab ❑Archive For Months longer than I month) <br /> Turn Around Time Required QC Requirements(Spectfy) <br /> W24 Hours ❑ 48 Hours ❑ 7 Days ❑ 14 Days ❑2 f Days E)other <br /> 1 R_elin amled By Date Time 1 Rec a By Date Time <br /> r 1 a6-0 12-11 1 Z. 1-7 <br /> 2 ReOn ey Rate rTome 279celved ay D1 to LTrme �w <br /> 3 Relinquished ByDate T—, 3 Received By Td <br /> e <br /> Comments <br /> DISTRIBUTION WHITE Returned to Client with Report CANARY Stays with the Sample PINK Foeld Copy <br />