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L0 <br /> a <br /> a <br /> Chain of STL <br /> Custody Record Severn Trent Laboratories, Inc. <br /> STL-4124 (0901) <br /> Client Protect Manager Date Chain of CustodV Number <br /> U91'5 mow(, m% ay103 100516 <br /> Address Telephone Nu r(Area Code)lFax Nuh4br Lab Number <br /> Page of 1 <br /> City State Zip Code Site Contact Lab Contact Analysis(Attach list if <br /> rn� � mores ace is needed <br /> Project Name and Location(Stats) Carrier/Waybill Number R CE:ID 0 CONDI310KAV? 1 <br /> a ti '�- A ND JC 'at Instr`ctlons/ <br /> ContreoWumhase Order/Ruote No. Containers& ' ond iarrs of acaipi <br /> Matrix Preservatives m M� <br /> Sample 1,D.No,and Description Data lime n � � o ] rQ� <br /> (Containers for each sample may be combined on one line) h y z N 3] <br /> rc�u1J- �� 4�0 5 a1. 3 INf <br /> L y <br /> a <br /> 0 <br /> w- <br /> �t1v�-3 3A, IX D�, <br /> y cv a' 713 <br /> 0 <br /> CD <br /> C <br /> ro <br /> U <br /> ILI I o <br /> maX 1C �lhcN� S <br /> u o3 Xio X <br /> Possible Hazard Identification Sample Disposal <br /> (A lea may be assessed if samples are retained <br /> ❑Non-Hazsrd El Flammable ❑ Skin Irritant ❑ Poison 8 ❑ Unknown ❑Return To Client Disposal By Lab 0 Archive For Months longer than i month) <br /> Tum Around Time Required OC Requirements(Specio <br /> ❑24 hours 0 4B Hours Q 7 Day 14 Days 9 ❑ ocher. /7- <br /> 1,Relinquished By Date Time <br /> Data Time <br /> �Sa3 )n )0 4D <br /> 2.Aelinqulshed By Q e Time 2.Receded By Date Trme <br /> 3_Relinquished By Date Time 3.Received ByD ale Time <br /> Comments <br /> h <br /> O <br /> N <br /> 1 <br /> D15TRIBUTIP9. - WHITE-Returned to Client with Report: CANARY•Stays with the Sample.- PINK-Field Copy <br /> ,k LL <br /> `'_ _ 0 <br />