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h 110 S. Hill Street �o" 3 <br />euro i 1 A s South Bend, IN 46617 Order# <br />T: 1.800.332.4345 <br />F: 1.574.233.8207 Batch # <br />t <br />£"�` 374.681 RP 10.1 <br />www eatonanalytfcal corn CHAIN OF CUSTODY RECORDPage of 1 <br />Shaded area for EEA use only <br />REPORT TO: <br />SAMPLER (Signature) <br />PWS ID # <br />STATE (sample origin) PROJECT NAME PON <br />S S-16, � sn���� <br />MC'-F4��� <br />w <br />SOURCE WATER ! Z <br />— + E` <br />BILL TO: <br />Yes <br />No <br />POPULATION SERVED <br />Sam' <br />COMPLIANCE <br />MONITORING <br />z w o <br />�� <br />F Q <br />i <br />zcs <br />o' <br />LAB Number COLLECTION <br />SAMPLING SITE <br />x <br />CHLORINATED U [C z <br />' <br />TEST NAME SAMPLE EMARKStAu x <br />DATE TIME AM PM <br />1 �l I N F- <br />S -J <br />2 3� <br />3 if <br />/ <br />4 <br />6 <br />I <br />5 <br />7 <br />9 <br />9 <br />10 <br />11 <br />12 <br />13 <br />14 <br />RELINQUISHED BY:(Signature) DATE TIME <br />RECEIVED BY:(Signature) DATE <br />TIME LAB RESERVES THE RIGHT TO RETURN UNUSED PORTIONS OFNON'-AOUFOUSSAMPLES TOCULNT <br />�j <br />q-ZT_ (� <br />N <br />.LA9;GaMMECIfent-Provided Sample ConWner ' <br />--a' <br />AM PMAM - <br />TIME <br />-iters Receivnd <br />RELINQUISHED BY:(Signature) <br />DATE <br />TIME <br />RECEIVED BY:(Signature) <br />DATE <br />AM PM <br />AM PM <br />RELINQUISHED BY:(Signature) <br />DATE <br />TIME <br />RECEIVED FOR LABORATORY BY: <br />DATE <br />TIME ONDITIONS UPON eFXE3PT{check one]: <br />0 b jJj� <br />0.1—Ambien! - `� °G Unon Receipt NIA <br />/ <br />AM PM <br />AM PM <br />MATRIX CODES: <br />TURN -AROUND TIME (TAT) ' SU NAR E5 <br />DW -DRINKING WATER <br />SW -Standard Written: (15 working days) 0% LV' = Immediate Verbal: (3 working days) 1001/1 - <br />RW -REAGENT WATER <br />RV' = Rush Verbat (5 working days) 50% tW=immediate Written, (3 working days) 125% Samples received unannounced with #c5s <br />GW -GROUND WATER <br />EW -EXPOSURE WATER <br />RSM' = Rush Written: (5 working days) 75% SP' = Weekend. Holiday CALL Ehan 48 hours holding lime remaining <br />he Subject to additional charges. <br />SW -SURFACE WATERmay <br />STAT' =Less than 0.B hours CALL <br />PW -POOL WATER <br />. <br />WW -WASTE WATER <br />* Please call. expedited Service not available for all testing 06 -LO -F0435 Issue 4.0 Effective Date: 2014-05-0, <br />16 <br />Sample analysis will be provided according to the standard EEANdater Services Terms, which are available upon request. Any other terms proposed by Customer are deemeo malenal alterations ana are re)ecied unless expressly ayree to to wnwiy uy <br />EEA_ <br />Page 19 of 20 <br />