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r r r r r r■� � <br /> WNWN��� <br /> Chain o ' <br /> Custody Record Severn Trent Laboratories, Inc. <br /> STL.4124 (0766) Pro ec a r to Chain of Custody Number <br /> 4ress <br /> j <br /> Teleph e Nu a (Area C e)/Fax Number ab umber <br /> < page Of <br /> Zip Code Site Co actLab Contact Analysis(Attach list d w mores ace rs needed) I <br /> Pr*co,,tr.c' <br /> ect me and Location(State) �� ,r CamerM/ayb+!!Number <br /> L11 Special instructions/ <br /> Conditions of Receipt <br /> ase OrdeMuote No Matnx Containers& <br /> b 6 0O/tiT Preservatives <br /> Sample 1 P No and Description Date Time <br /> (Containers for each sampfe may be combined on one line) <br /> { { f'Cc) <br /> E <br /> a � <br /> po i le Hazard Identification Sample Disposal (A lee may be assessed if samples are retained <br /> on Hazard ❑ Flammable ❑ Skin tmtanf ❑ poison B ❑ Unknown ❑ Return To Client osa!By Lab ❑Archive For Months longer than 3 months) <br /> QC Requirements(Specify) <br /> Tum Around Time Required <br /> 24 H urs ❑ 48 Hours ❑ 7 Days ❑ 14 Days ❑ 21 Days Other Date Time <br /> Date„ Time 1 Received By <br /> Relinq shed By / <br /> 1 Date Time <br /> to Time 2 R(Aeived By )III I e/ <br /> Retlnqur //l.��J ` Z J <br /> Da,e Time <br /> D to Time 3 Received By 1 6 3-Z--)3 l+ +shed By QGy Q� 5 <br /> I <br /> omments <br /> DISTRIBUTION WHITE Stays with the Sample CANARY Returned to Client with Report PINK Field Copy <br />