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o <br /> Chain of <br /> Custody Record <br /> Severn Trent Laboratories, Inc <br /> ;TL-4i24 (1200) <br /> Client Project Manager Date Chain of Custody Number <br /> Z4 — u �� 085835 <br /> Address Telephone Number(Area C de)/Fax Number Lab Number <br /> f! a 7 -zod c) Page of <br /> City StateZip Code Site Contact Lab Contact Analysis(Attach list if <br /> ��� mores ace is needed <br /> Project Name and Location(State) Carner*Veybill Number <br /> r ��p <br /> Special instructions/ <br /> ContraclIPurchaSe OrderlQuote No. Containers 8 Conditions of Receipt <br /> Matnx Preservatives <br /> Sample I.D. No. and Description o o <br /> Date Time <br /> (Containers for each sample maybe combined on one tine) a ,� N $ z m <br /> 2 2 N2 <br /> m !qo !/LT,* l 015 <br /> COfrjITlt?N <br /> 7 =' �fo1 A l��la v /3zs' u o> r <br /> Z o 3 <br /> 002 <br /> 1141 <br /> G� <br /> Passible l-lazartrldentification Sample Disposal <br /> r,� (A lee maybe assessed if samples are retained <br /> LR Non-Hazard El Flammable El Skin Irritant ❑ Polson B ElUnknown ❑ Return To Client Disposal By Lab ❑Archive For Months longer than 3 months) <br /> Turn Around Time Required QC Requirements(Specify) <br /> ❑ 24 Hours ❑ 48 Hours ❑ 7 Days ❑ 14 Days PTI Days ❑ Other <br /> 1.Relinquished By Date Time I.Received By Date Time <br /> /a �o s- loz <br /> Relinquished By Dat Time e ry y Dae Time <br /> _JjC '"�° $' J7/Q� !L�`z X31"7-bz � <br /> 3.Relinquished By Date Time 3.Re ived By Date Time <br /> Comments <br /> 0 )ISTRIBUTION: WHITE-Stays with the Sample; CANARY-Refurned to Client with Report; PINK-Field Copy <br />