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`CHAIN O. CUSTODY RE IUD <br />GS Envi 'mental Servic ` inc. <br /> <br />a • Alaskaocatlons NationwiHawaii <br />• Ohio • Maryland <br />• New Jersey • North Carniina <br />• West Virginia <br />www.us.sgs.crom p 7 9112 <br />CLIENT: i. '1 ~. <br />V~,J SGS Reference: <br /> <br />~' <br />~ <br />PAGE <br />i~ <br />CONTACT PHONE NO:( ~ _ ~~ bQ <br />. p <br />4C.>~ ZS7 <br />Preservati <br />PROJECT: ~ SITE/PWSID# : ( N o STMPFE Usetl <br /> Analysis <br />f2EPORTS TO: E-MAIL: <br /> <br /> <br />FAX NO.:( ) C <br />Q <br />N <br />T <br />C= <br />COMP Required <br /> <br /> <br />O s <br />INVOICE TO: <br /> <br />2 ~ QUOTE # <br />P.O. NUMBER A <br />N <br />E GRAB ~ <br /> <br />LAB NO. <br />SAMPLE <br />ENTIFICATION <br />DATE <br />TIME <br />MATRIX R <br />g <br /> <br />REMARKS <br />~J' 00 $ o I 5~ 3 <br /> <br /> <br /> <br /> <br /> <br /> <br /> r <br /> i <br /> 4 t <br />S <br />Collet 'sh~d,~y:(1) <br />6 \C Date <br />O• ~Q Time <br />~ R c By: Date <br />1 ~'~ Time <br />~r~~ Shippi Carrier: i <br />Shippi' g Ticket No: Samples Received Cold? (Circle) NO <br />Temperature JC:_. ~ r <br />Relinquished B (2) Date Time eceived By: Date Time Specia Deliverable Requirements: <br />I Chain of Custody Seal: (Circle) <br />INTACT BROKEN ABSENT <br />Relinquished B : (3) Date Time Received By: Date Time Specia Instructwns: <br />Relinquished B (4) Date Time Received By: Date Time Requ ted Turnaround Time: <br />^R SHE; ^STD <br />Date Needed <br />ti 200 W. Potter Drive Anehonga, AK 99518 Tel: (907) 562-2343 Fax: (907)561-5301 O 1270 Greenbrier Street Chadaston, WV 2 11 Tel: (304)348-0725 Fax: (304) 346-0761 ••~ ~ • nounneo uy <br /> wu <br />O 5500 Business Drive tMlminaton, NC 28405 Tel: (910) 350.1903 Fax: (910) 350-1557 Yellow - Returned with Report i <br />„+~ ') Pink - Ratainnd by Samninr i <br />