2008-10-22_REPORT - C1981008 ‎(3)‎

• Permit No: C1981008
• IBM Index Class Name: REPORT
• Doc Date: 10/22/2008
• Doc Name: 2008 AHR Appendix C Part 3
• From: Western Fuels-Colorado
• To: DRMS
• Annual Report Year: 2008
• Permit Index Doc Type: Hydrology Report
• Email Name: MLT
• Media Type: D
• Archive: No

CHAIN OF CUSTODY RECORD
SGS North America Inc.
O 1501-A East Patapsco Avenue Baltimore, MD 21226 'Tel: [phone] Fax: [phone]
O P.O. Box 850 Sophia, WV 25921 Tel: [phone] Fax: [phone]
0 216 Oxmoor Circle Birmingham, AL 35209 Tel: [phone] Fax: [phone]
0 5793 MaeCorkle Avenue SE Charleston, WV 25304 Tel: [phone] Fax: [phone]
•
0 2979 East Center Street Conneaut, OH 44030 Tel: [phone] t-.A: [phone]
0 1101 Howard Drive Deer Park, TX 77536 Tel: [phone] Fax: [phone]
0 4665 Paris Street, Suite B-200 Denver, CO 80239 Tel: [phone] Fax: [phone]
O 2804 Hackathorne Lane Gillette, WY 82716 Tel: [phone] Fax: [phone]
O Route 2, Box 162A Middlesboro, KY40965 Tel: [phone] Fax: [phone]
015550 N. Lombard - Terminal 5 Portland, OR 97203 Tel: [phone] Fax: [phone]
0 16130 Van Drunen Road South Holland, IL 60473 Tel: [phone] Fax: [phone]
• CLIENT. SGS Reference:
?
h

CONTACT: j PHONE NO:?
)
E No

U l r ! 1 '
PAGE
OF
?
alk,
4 P

PROJECT. SITE/PWSIO#:
NO
SAMPLE
TYPE rneaal rn
Used
Anal
sis
REPORTS TO: (? owza
t?
Q14Z+ FAXNO.:(` 70 $(ia 1,2
1 O
N
T C-
COMP y
Roquired
O?

INVOICE TO: x' y5,.t QUOTE #:
07? WS
P.O. NUMBER:
2- ?4 0 g 1 A

N
E -
GRAB

r
"`YJ

LAB NO.
SAMPLE IDENTIFICATION
DATE
TIME
MATRIX R
S
(V
REMARKS

5 4
Collected/ uls By:(1) Date Time Received By: Shipping Carrier:
Shipping Ticket No: Samples Received Cold? (Circle YES NO
Temperature C: i o CI)
Relinquished By: (2) Date Time Received By: Special Deliverable Requirements: Chaor-Custody Seai:'(Circle)
INTACT BROKEN ABSENT
Relinquished By: (3) Date Time Received By: Requested Turnaround Time and Sp ructions:
Relinquished By: (4) Date Time Rece ed By. , kAA nrv in,i