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--------- ------ - ----- -- <br /> .7 7 <br /> Chain <br /> L <br /> M WITMI . <br /> Custody Record Severn Trent Laboratories, Inc. <br /> 87L-4124 �09011 <br /> Client Project Manager Date Chain of CustodV Number <br /> 0 on�_J C-"\k M� 3 100516 <br /> ft <br /> Address Telephone Naer(Area Code)/Fax Nug�kr Lab Number <br /> a�J-T-)/ P I t_�( )-Ip- a, cf�\C Page_1__ of <br /> City state Zip Code Site Contact LabContactAnalysis(Attach list it <br /> mores ace is needed) <br /> r.I <br /> -a i <br /> Project Name and Location(State) CarrierMaybill Number <br /> C <br /> "' -�I Special Instructions/ <br /> Contract/Purchase Order/Quote No, Containers& Conditions of Peceipt <br /> Matrix Preservatives <br /> Sample I.D. No. and Description Date Time <br /> (Containers for each sample may be combined on One line) <br /> L) <br /> T_ <br /> "k <br /> Possible Hazard Identification Sample Disposal (A fee may be assessed if samples are retained <br /> 0 Non-Hazard 0 Flammable El Skin Irritant El Poison B 0 Unknown El Return To Client Disposal By Lab El Archive For Months longer than I month) <br /> Tura Around Time RequiredOC Requirements(Specify) <br /> El C 24 Hours [1 48 Hours ❑ 7DaA A 14 Day ❑ 0lh.'__ <br /> 1.Relinquished By Date Time 7 I Date Timo <br /> A-, <br /> 2. Relinquished By e Time 2.RaceiJed By Dale Time <br /> 3.Relinquished By Dale Time 3.Received By Date Time <br /> Comments <br /> DISTRIBUTION: WHITE-Returned to Client with Reporr CANARY-Stays with the Sample: PINK-Field Copy <br />