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Chain of ® STLSTLDenver <br /> 4955 Yarrow Street <br /> Custody Record Severn Trent Laboratories, InC. Arvada, CO 80002 <br /> STL4124 (090„ <br /> Client Project Manager Date Chain of Custody Number <br /> Atldress Telephone Number(Area Code)/Fax Number Lab Number <br /> Page of <br /> City State LP Code Sire Contact Lab Contact Analysis(Attach list if <br /> ore Space is needed) <br /> i <br /> Pic t Nand Loc ion(State) CamierrWaybill Number <br /> 1111, Speciallnstructions/ <br /> nlractOurcha a OrderlQuot-1,10. Containers& Q Conditions of Receipt <br /> OMatrix preservatives 1 <br /> Sample/.0.No.and Description . Date Time <br /> (Containers/or each sample be combined on one line),_ d F � 4 1 <br /> 3 oz x 2o <br /> Possible Hazard Identi/irahon Sample Disposal <br /> (A tee may be assessed ilsamples are retained <br /> Non-Hazard ❑Flammable ❑ Skin Irritant ❑ Poison B ❑ Unknown ❑Retum To Client ❑ Disposal By Lab ❑Archive For Months longer man 1 n Jnth) <br /> Turn Around Time RegJ ed OC Requirements(Specify) <br /> ❑ 4 Hours 48 Hours [:17 Days ❑ 14 Days ❑21 Days ❑ Other <br /> 1.R Ihqurshed By Dale Time I. Date Time <br /> 41 04 <br /> 2.Relinquished By Calf f Time 2.Received By _r -.._. Date Time <br /> 3.Relinquished By Date Time 3.Received By Dale Time <br /> Comments <br /> Vie- P,O. �. I <br /> DISTRIBUTION: W TE-F4turnetl to Client with Report; CANARY-Stays with the Sample: P/NK-Field Copy <br />