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............... . . . -1.11.1 1-1-1- 0 <br />• <br />CHAIN OF CUSTODY RECORD 02979 East Center Street Conneaut, OH 44030 Tel: (440) 224-2261 I-bx: (440) 224-2808 <br />SGS North AmedCa Inc. 01101 Howard Drive • Dear Park, TX 77536 Tel: (281) 930-1919 Fax: (281) 479-4969 <br />it 6 ?r 0 4665 Paris Street, Suite B-200 Denver, CO 80239 Tel: (303) 373.4772 Fax: (303) 373.4791 <br />0 1501-A East Patapsco Avenue Baltimore, MD 21226 Tel: (410) 355-1958 Fax: (410) 355-1965 0 2804 Hackathorne Lane Gillette, WY 82716 Tel: (307) 682-7917 Fax: (307) 682-7951 <br />" 0 P.O. Box 850 Sophia, WV 25921 Tel: (304) 255-0422 Fax: (304) 255-0417 0 Route 2, Box 102A Middlesboro, KY 40965 Tel: (606) 248-4205 Fax: (606) 248.0044 <br />U 216 0.xmoor Circle Birmingham, AL 35208 Tel: (205) 942-3120 Fax: (205) 942-0914 0 15550 N. Lombard - Terminal 5 Portland, OR 97203 Tel: (503) 285-5905 Fax: (503) 285.5086 <br />O 5793 MacCorkie Avenue SE Charleston, WV 25304 Tel: (304) 925.6631 Fax: (304) 925-8877 0 16130 Van Drunen Road South Holland, IL 60473 Tel: (708).331-2900 Fax: (708) 333.3060 <br />9 <br />CLIENT: t Al? l? J? L /t O? <br />?? l <br />SGS Reference: <br />(,rE <br /> <br />PAGE OF <br />? <br />) <br />' PHONE NO:( X , <br />bV f <br />t? ( <br />9;v <br />CONTACL <br />7 <br />lnes <br />Prove" <br />SITEIPWSID#: No STTYPEE Used <br />I <br />PROJECT: C Analysis .. i <br />REPORTS TO:;? <br />fJ b K ?o Z$ <br />?V C D g/4Z'4 FAX NO.:(g 7Q) T L G8 <br />N <br />T <br />Co nP Req? <br /> <br />3 v (Pt <br />INVOICE TO: S? QUOTE #: <br />t?xN?j a? k? S <br />a $ /T?2j0. NUMBER: <br />2 ? A <br /> <br />E GRAB rr <br /> <br />LAB NO. <br />SAMPLE IDENTIFICATION <br />DATE <br />TIME <br />MATRIX R <br />S <br />REMARKS <br /> 01 . 24 $a W '? <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />5 <br />Collecte uish?J :(1) <br />Date <br />Time 4 <br />Received By: Shipping Carrier: l J S <br />Shipping Ticket No: <br />Samples Received Cold? (Circie? YES1 NO <br />Temperature°C:? <br />Relinquished By: (2) Date I ime Received By: Special Deliverable Requirements: Chain of Custody Seal: (Circle) <br />IWACT;;; BROKEN ABSENT <br />Relinquished By: (3) Date Time Received By: Requested Turnaround Time and Specaa! Instructions: <br />Relinquished By: (4) Dat (( Time <br />'?ON R d Bq: n <br />I *A <br />SGS COC Rev 2/07 White - Ketamen DW Laa