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<br />CHAIN OF CUSTODY RECORD <br />SGS Enviromental Services Inc. <br />Locations Nationwide <br />• Alaska • Hawaii <br />• Ohio • Maryland <br />• New Jersey • North Carolina <br />• West Virginia 0 7 9 0 4 <br />www.us.sgs.com <br /> <br />CLIENT: <br />' ~ <br />SGS Reference: <br /> 2 <br />PAGE <br />„~--7 <br />ONTACT Q <br />PHONE NO:(g7 <br />) <br />~ <br />0 '~ ~ ~O J Z, ~ ' - <br />: <br />C p <br />~ <br />! <br />~- <br />- <br /> 1 <br />`` (( <br />1 Preservafives <br />?~ SITE/PWSID# : <br />PROJECT N o STMy1PEE used z <br />: Analysis ~ <br />REPORTS T ~ E-MAIL: Cv <br />o Repaired <br /> N i~nP <br />c <br />3 <br />O <br /> FAX NO.:( ) T <br /> A G= a <br />INVOICE TO:~ QUOTE # I GRAB <br />~ P.O. NUMBER N <br />2 ) <br /> R <br />LAB NO. SA '~vIPLE IDENTIFICATION DATE TIME MATRIX g <br />REMARKS <br />2 S ~ ~- ~ ej W "Z.. ~ t. <br />i <br />S Y (f <br /> <br />`i <br />i 1 <br /> <br /> <br /> ) <br /> <br /> <br />C <br /> ^ <br />5 <br />1ingy:(1) <br />Colle Dat T Res.~iw Date Time 4 <br />Shipping Carrier: V ~~j ? <br />(Circle NO <br />Samples Received Cold <br />- <br />V^~{~~ ~•e1 <br />!v ~' ~ ( Shipping Ticket No: i <br />' <br />Temperature IC: 'T I 3 <br />Relinquished By: (2) Date Time Received By: Date Time Special Deliverable Requirem ts: Chain of Custody Seal: (Circle) <br /> INTACT BROKEN ABSENT <br />Relinquished By: 3) Date Time Received By: Da Time Special Instructions: <br />Relinquished By: (4 Date Time Received By: Date Time Requested Turnaround Time: <br /> ~/Z3 (~0 ` <br />~ ^ RUSH ^ STD <br /> Date Needed <br />01200 Wgpotter Drive Anohorege, AK 99518 Tel: (907) 562-2343 Fax: (907) 561-5301 O 1270~eenbrier Street Charleston, VYV 25311 Tel: (304)346-0725 Fax: (304) 346-0761 ^^~~~ ~~~uunnu uy <br /> ~.av <br />Yellow - Relumed with Report <br />n r;con il~.lnnvc nrive WIIminoton. NC 28405 Tel: 1910) 350-1903 Fax: (910) 350-1557 Pink - RetaingA by Ramninr <br />