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i <br />CHAIN OF CUSTODY RECORD <br />-S%m SGS North America Inc. <br />O 150 - ast Patapsco Avenue Baltimore, MD 21226 Tel: (410) 355-1958 Fax: (410) 355-1965 <br />17150. Box 850 Sophia, WV 25921 Tel: (304) 255-0422 Fax: (304) 255-0417 <br />O 216 Oxmoor Circle Birmingham, AL 35209 Tel: (205) 942-3120 Fax: (205) 942-0914 <br />? 5793 MacCorkle Avenue SE Charleston, WV 25304 Tel: (304) 925-6631 Fax: (304) 925-8877 <br /> <br />0 2979 East Center Street <br />0 1101 Howard Drive <br />0 4665 Paris Street, Suite B-200 <br />? 2804 Hackathorne Lane <br />0 Route 2, Box 162A <br />O 15550 N. Lombard - Terminal 5 <br />? 16130 Van Drunen Road <br />Conneaut, OH 44030 <br />Deer Park, TX 77536 <br />Denver, CO 80239 <br />Gillette, WY 82716 <br />Middlesboro, KY 40965 <br />Portland, OR 97203 <br />South Holland, IL 60473 <br />Tel: (440) 224-2261 Fa: 1) 224-2808 <br />Tel: (281) 930-1919 Fax: k,dt) 479-4969 <br />Tel: (303) 373-4772 Fax: (303) 373-4791 <br />Tel: (307) 682-7917 Fax: (307) 682-7951 <br />Tel: (606) 248-4205 Fax: (606) 248-0044 <br />Tel: (503) 285-5905 Fax: (503) 285-5086 <br />Tel: (708) 331-2900 Fax: (708) 333-3060 <br />i <br />CLIENT: <br />COL,o <br />SGS Ref? <br />rence: bo <br />. <br />60 <br />PAGE 0F <br /> <br />PHONE NO:( <br />) <br />CONTACT b <br />- ' <br />? <br />x <br />9 <br />! 70 <br />70 <br />8(-4 <br />o <br />? <br />Presmalives <br /> <br />, <br />PROJECT: SITE/PWSID# : No SAMPLE <br />TYPE Used I to <br /> Analysis / <br />REPORTS TO: T yY <br />T?L?OX (D Z8 t <br />Z FAX NO.:( 70) L T, tit, <br />"Llej-h 60 <br />1 O <br />N <br />T C= <br />COMP Required <br /> <br />O <br />0 <br />i <br />INVOICE TO: yS-- Xk ? QUOTE #: <br />VV\ Po6? ? 18 <br />P.O. NUMBER: <br />2, T <br />A <br /> <br />E <br />N G= <br />GRAB <br /> <br />?- <br />J <br /> <br />LAB NO. <br />SAMPLE IDENTIFICATION <br />DATE <br />TIME <br />MATRIX R <br />S <br />REMARKS <br /> ., 3.??.cfj tl3a SW 2 ?? <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> 4 <br />5 <br />Collected/Relinquis a y:(1) <br />1 <br />)l L Date <br /> <br />34L Time <br /> <br />lza Received By: Shipping Carrier: <br /> <br />Shipping Ticket No: Samples Received Cold? (Circle)." NO <br /> <br />Temperature°C:?_ <br />Relinquished By: (2) Date <br />J?? Time Q <br />Ip • !O Received By: <br />?J? Special Deliverable Requirements: Chain of Custody Seal: (Circle) <br />TACT BROKEN ABSENT <br />Relinquished By: (3) Date Time Received By: Requested Turnaround Time and Special Instructions: <br />Relinquished By: (4) <br />r' Date Time Received By: