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~u~ <br /> <br />CHAIN OF USTODY RECORD <br />SGS En ~ ironmentat Services Inc. <br />Locations Nationwide <br />• Alaska • Hawaii <br />• Louisiana • Maryland <br />• New Jersey • North Carolina <br />• West Virginia - ~ ^ <br />wvvw.us.sgs.com b <br />1 <br />CLIENT: ~~ <br />SGS Reference: <br />f~ <br /> <br />PAGE~ <br />O <br />PHONENO:(( <br />) ~L~ <br />CONTACT: <br />? ~ O ~~ Q6 <br />1 _ <br />t~ <br />. <br />~ Prexrvauves <br />PROJECT: SITE/PW51D# : N O SAMPLE <br />TYPE Used <br />Y Analysis <br />EPORTS TO: E-MAIL: <br />9 <br />FAX NO.:( ) <br />' C <br />~ <br />N <br />T COMP Required /~ i <br />O3 7/U <br />INVOICE TO: QUOTE # <br />P.O. NUMBER <br />2: A <br />N <br />E GRA6 <br /> <br />LAB NO. <br />SAMPLE IDENTIFICATION <br />DATE <br />TIME <br />MATRIX R <br />S <br /> <br />REMARKS <br /> N P Z s 0,22 o w ~- G ` <br /> <br /> <br /> <br /> <br /> <br /> <br /> ~. <br /> <br /> 4 <br />Collec d qui d By:(1) <br /> <br />~ Date <br />,d~ <br />V,L~' Time <br /> <br />t'~ Rec ' Shipping Carcier: V PS <br />f <br />Shipping Ticket No: 5~m <br /> <br />Tem ples Received Cold? (Circle YES NO <br /> <br />perature JC: ~ _ r -__~--___._ <br />Relinquis By: (2) Time 'Received By: Special Deliverable Requirements: Chain of Custody Seal: (Circle) <br />NTACT BROKEN ABSENT <br /> <br />Relinquished By: (3) <br />t <br />j <br />Date <br />Time <br />,Received By: <br /> <br />f <br />Requested Turnaround Time and Special Instructions: <br />Relinquished By: (4) ~DOate Time Rec ived By: ~ <br />__"1.~''~. Whifa - Ra1at,.e~ n., 1 ..1, <br />O 200 W. Potter Orive Anchorage, AK 99518 Tel: (907)582-2343 Fax: (907) 581-5301 ^ 1270 Greenbrier Street CharlestonYYV zs3n iN: t:wa) s4o-urzo rax: tsunt .~ao-or Yellow - ftetumad wiUt <br /> H¢port <br />J 5500 Business Odve Wilmington, NC 28405 Tel: (910) 350-1903 Fax: (910) 350-15 Pink • f2etained by Sampler <br />