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4&M = = = M 56 ■r <br /> Vm6r = <br /> Chain of <br /> Custody Record Severn Trent Laboratories, Inc <br /> STL-4124 (4700) <br /> Chenj---, Prole an g r Date Chain of Custody Number <br /> L61 aP s 3 <br /> Address Tel one Nu ber(Area Code)/Fax Number Lab Number <br /> 1 f ( Z S� _4? Page of <br /> fe-crty State Zip Code site contact Lab Contact Analysis(Attach fist if <br /> f� <br /> l a f� r /'� mores ace is needed <br /> CA Project Location(S ate) 7 Carrier/Waybill Number <br /> L lA SWI N 17 3 3 { Special Instructions/ <br /> ContractfPur�ase OrderlQuote No Containers& Conditions of Rereipt <br /> C`�!�(_[� Matrix Preservatives <br /> ° <br /> Sample/D No and Descnpbon a <br /> Date Time m a G <br /> (Containers for each sample may be combined on one line) CO COO <br /> x x <br /> V V ��J 1 `• JV <br /> RA W <br /> Possible Hazard Identification Sample Disposal (A tee may be assessed if samples are retained <br /> 15don Hazard ❑ Flammable ❑ Skin Irritant ❑Poison B ❑ Unknown ❑Return To Client Disposal By Lab ❑Archive For Months longer than 3 months) <br /> Tum Around Time Required OC Requirements(Specify) <br /> ❑ 24 urs ❑ 48 Hours ❑ 7 Days ❑ 14 Days ❑ 21 Days ❑ Other <br /> Rebn ishe By Date Time f Received ByDate Time <br /> I1512 r <br /> 2 Relingwshe y Date Ti2 erved By Date Time <br /> me <br /> kZ'f V:k mz <br /> 3 nquished By ate ime 13 Received By Date Time <br /> — <br /> o ns V . � f ISZ7D <br /> DISTRIBUTION WHITE Stays wdh e am e CANARY Returned to Client with Report PINK Field Copy <br />