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0 <br /> w Chain of <br /> STL <br /> y Custody Record Severn Trent laboratories, Inc. <br /> STL-4124 (091) <br /> Client Project Manager Date Chain of Custody Number <br /> 130964 <br /> Address Telephone Number(Area Code)/Fax umber Lab Number <br /> 28'+0 6atrwa t>r-tes S..:Fe 300 R16 ' 6-+R- Z�33 416- 6�4- L9oo Page of <br /> CityStatep Code Site Contact tab Contaff Analysis(Attach list if <br /> 5'aera&%epr4c> ICf 1 9SS., 33 mores ace is needed <br /> Project Name and Location(State) Carrier/Waybill Number <br /> F P 7�o/ west 1.%, (a tont � 'M Special Instructions/ <br /> CantracWurchase Order/Ouote No, 4 q d Conditions of Receipt <br /> Containers& i p <br /> Matrix Preservatives G 00 4 <br /> Sample I.D.No.and Description o _ r �r �_ x <br /> {Containers for each sample may be combined on one line) Date Time h U o o 0 4 <br /> m rt - i 9.2 S'.,0.3 4.10 X 2. 3 1 1 Ix x -v- C 9/= <br /> r- <br /> co <br /> v Dr'� w- �t•2Sa boas ?� Z 3 � X <br /> •25-03 totrsr 13 Y x <br /> s <br /> w- 'q•zr 03 it s o -43 x K <br /> Mw- -+0 4,25-03 1115- L 3 k �c <br /> 0 <br /> 0 <br /> 0 <br /> Possible Hazard Identification Sample Disposal <br /> (A fee may be assessed if samples are retained <br /> Of Non-Hazard ❑ Flammable ❑ Skin irritant ❑ Porson B ❑ Unknown ❑Return To Client ❑ Disposal By Lab ❑ArcMive For Months longer than I month) <br /> Tum Around Time Required OC Raquirements pecify) <br /> ❑ 24 Hours, ❑ 48 Hours ❑ 7 Days i4 Days ❑ 21 Days ❑ Other <br /> f. elinquished Sy Date Time Date/ Tire*3 p <br /> z!3 D 17� ! <br /> 2.Relinquished By Date Time 2.Recelled By U Date Time <br /> 3,Retinquistred By Date Tima I.Received 8y Dale Time <br /> A Comments <br /> ►;L-De.,+ rnvf/� OX C r <br /> DISTR18t1 ":';,'j WHITE-Returned to Client WIXPepoil, CANARY•Stays with the Sample: PINK•Field Copy -� <br /> �-M -.-a._._-. _—.._r M .Sm IMM <br />