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No <br /> Chain of STL <br /> Custody Record Severn Trent Laboratories, Inc. <br /> STL-4124 (0901) <br /> client Project Manager Date Chain of Custody Number <br /> J22 - a ®� 63 <br /> Address Telephone Number(Area Code)/Fax Number Lab Number <br /> 'r/(a. 7ee. • /y7 / 9/6 . 75'6Page—1 of <br /> city Slate Zip Code Site Contact Lab Contact Analysis(Attach list if <br /> mores ace is needed <br /> Project Name and Location(Slate) Carrs ra ayblll Number \ N h k <br /> Y"2,4Cy <br /> ConMactlPurchaseaseOrdedOuole No. c V N S Special Instructional <br /> Containers& v y o �u v 3bo <br /> � <br /> Matrix <br /> bgso7- Conditions of Receipt <br /> - ogoz ' - no0o Preservatives .A � b 2 � � � � <br /> Sample 1.0.No.and Description v �Y <br /> (Containers lot each sample may be combined on one fine) Date Time <br /> 2 y m � y`V r r � NZ 'J � � �/ ? \ � •1� <br /> Pyr -/ 4-zz -a3 Ot'3 r7 � 2 / y / X < x xx x c x c� fA�✓4 f-icr <br /> a.� - z 4-yz-cj rzYo X s Z / X >< sl ><X <br /> 0 <br /> m <br /> NRE EIV M I i G ODJ�Ot DIT ON USI-1 Ta— <br /> m <br /> $ kEX C✓ <br /> AN 22 013 <br /> I <br /> Possible Hazard Identification Sample Disposal <br /> El -- <br /> (A fee may be assessed it samples are retained <br /> NomHazartl ❑Flammable ❑ Skin Irritant ❑ Poison 8 Unkrwwn ❑Rem lent ❑Disposal By Lab ❑Archive For Months longer Than I month) <br /> Turn Around Time Required OC Requirements Requirements(Specify) <br /> ❑24 Hours El48 rs E) T Days ❑ 14 Days El21 Days Of @r -6-k <br /> n uish <br /> Date `-� Dwe� 1.ReceivetlH Dale Time n � <br /> 6-Lr-22 0' 97,0? -va-V [� <br /> 2. dBY Dale Time 2.Received y Date Time <br /> 3.Relinquished By Dale Time 3.Received By Dale Time <br /> a Comments <br /> 0 <br /> m <br /> DISTRIBUTION: WHITE Retumetl to Client with Repon; CANARY Stays with the Sample; P1NK Field Copy <br />