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Chain of <br />ACustody Record <br />STL-0124 (1200) <br />r <br />Severn Trent Laboratories, Inc'. <br />Client <br />Project Man ger <br />K -A t��v 4,24 <br />Date Chain of custody Number <br />q /-7 /v 3 085101 <br />Address — <br />JE -6 1�6 V �I2-S'i O %�iLG✓ <br />Telephone Number (Area Code)/Fax Number Lab Number <br />6 .� 37�i ' L%3 (i Z✓ % Z ��% 7 (o <br />Page f <br />City Stafe Zip Code <br />J % T Gi2� C G , (, U� <br />Site Contact Lab Contac <br />Analysis (Attach list if <br />more space is needed <br />of <br />Project Name and Location (State) <br />Q S-0 j � <br />Carrier/Waybill Number <br />J <br />Contract/Purchase Order/Quote No. <br />� <br />Special Instructions/ <br />Matrix I? Containers & <br />.q Preservatives <br />Conditions of Receipt <br />Sample 1.D. No. and Description ) <br />for each sample may be combined on one line Date <br />o 0 0 <br />Time $ Q <br />-J, <br />2 S 6 J J.✓ �-f <br />a a y j 2 x T 2 N2 <br />J; o 0 <br />r <br />n> <br />n� <br />0 <br />J <br />s <br />T <br />1 n — <br />— <br />SamnlP <br />l�iCrviCal <br />❑ Non -Hazard <br />Turn Around Tin <br />❑ 24 Hours! <br />By <br />J. Relinquished By <br />❑ Flammable n Skin 1—t-1 n 95..1—., o P 1 I M . <br />48 Hou%y a 7 D// ❑ 14 Days ❑ 21 <br />Cher <br />W��� / Time 1. <br />-7 0-7 t51c:i <br />gateTame 2. <br />v3 0 <br />late , Time 3. <br />WComments <br />cn <br />0 <br />SQ/STRIBUTION: WHITE -Stays with the Sample; CANARY- Retumed to Client with Report; PtNK - Field Copy <br />>isposal By Lab ❑ Archive For <br />Requirements (Specify) <br />(A fee may be assessed if samples are retained <br />Months longer than 3 months) <br />Date <br />te <br />Da�t��-�z I Time <br />r,�c� <br />Date <br />