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CHAIN_ OF CUSTODY RECORD J 2979 East Center Street Conneaut, OH 44030 Tel: (440) 224-2261 Fax (440) 224-2808 <br />SGS North America Inc. J 1101 Howard Drive Deer Park, TX 77536 lei: (281) 930-1919 Fax: (281) 479-4969 <br />-J 4665 Paris Street, Suite <br />J 1501-A East Patapsco Avenue Baltimore, MD 21226 Tel: (410) 355-1958 Fax: (410) 355-1965 J <br />804 Hack tho me Lane B 200 Denver, <br />WY 82716 Tel: (307) 682-7917 Fax: (307) 682-7951 <br />J P.O. Box 850 Sophia, WV 25921 Tel: (304) 255-0422 Fax: (304) 255-0417 J Route 2, Box 162A <br />J 216 Oxmoor Circle Middlesboro, KY 40965 Tel: (606) 248-4205 Fax: (606) 248-0044 <br />Birmingham, AL 35209 Tel: (205) 942-3120 Fax: (205) 942-0914 J 15550 N. Lombard - Terminal 5 Portland, OR 97203 Tel: (503) 285-5905 Fax: (503) 285-5086 <br />J 5793 MacCorkle Avenue SE Charleston, WV 25304 Tel: (304) 925-6631 Fax: (304) 925-8877 J 16130 Van Drunen Road South Holland, IL 60473 Tel: (708) 331-2900 Fax: (708) 333-3060 <br />1 <br />CL1EN r <br />Q- CSGS Reference: ? ? ?? ?? <br />1 l'? 6? t Q PAGE_ OF <br />CONTACT PHONE NO:(#7v) <br />PROJECT: Preservatives <br />SITElPWSID#: No SAMPLE used <br />TYPE <br />REPORTS TO:?' C Requirequii <br />N .alysm <br />h7&4L1Nt s ? Avr- O C- Red Q <br />h7 <br />414 FAX NO.:( f,'? 2. ? ? N COMP T O <br />1 U ?p <br />Vpcf't f# <br />INVOICE TO. ?0 t go x }? BLS QUOTE #: A G Z L? <br />p GRAB <br />MULAA LV g 0 P.O. NUMBER E ? <br />2 <br />LAB NO. SAMPLE IDENTIFICATION R <br />DATE TIME MATRIX S <br />REMARKS <br />N oe S oq s w 3 <br />5 <br />Collected/Relinquished By:(1) Date Time Received B 4 <br />y: Shipping Carrier: Samples Received Cold? (Circl YES "10 <br />r C <br />4.1-05 //do Shipping Ticket No: Temperature°C:__ l <br />Relinquished By: (2) Date Time Received By: <br />Special Deliverable Requirements: Chain'ot,,Custody Seal: (Circle) <br />INTACT BROKEN ABSENT <br />Relinquished By: (3) Date Time Received By: <br />Requested Turnaround Time and ecial Instr ons: <br />Relingwshed By: (4) t? Time f[ ved