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					                        SUBURBAN LABORATORIES, Inc.                                                                                            CHAIN OF CUSTODY RECORD #                                                  Electronic Version
                        4140 Litt Drive Hillside, IL 60162                     Tel. 708.544.3260         Fax: 708.544.8587             Toll Free: 800.783.LABS              www.suburbanlabs.com
Company Name
                                                                                                           TURNAROUND TIME REQUESTED                                ANALYSIS & METHOD REQUESTED
                                                                                                                                                                                                                Page              of
Company Address                                                                                                                          *Additional Rush                                                       PO No.
                                                                                                         Normal             RUSH*       Charges Approved.
                                                                                                                                                                    Enter an "X" in box below for request
City                                                 State       Zip                                                                                                                                            Shipping Method
                                                                                                   *Date & Time Needed:
Phone                                                Fax                                            Normal TAT is 5-7 work days for most work. Rush work must be                                                 QC Reporting
                                                                                  Fax Report                 pre-approved and additional charges apply.                                                             Level               1       2       3
Email Address                                                                                        Specify Regulatory Program:
                                                                                                                                             None/Info only                                                              LAB USE ONLY
                                                                                                              (Required)
Project ID / Location                                                                                                                                                                                           SLI Order No.
                                                                                                         LUST                SRP                 SDWA
Project Manager (Report to)                                                                                                                                                                                         Sample containers
                                                                                                         503 Sludge          NPDES               MWRDGC                                                           supplied by customer?             Yes
Sample Collector(s)                                                                                                                    *Please specify in comment                                                 Temperature of
                                                                                                         Disposal            Other     section below.                                                            Received Samples
                                                                                                                                                                                                                                                    o
                                                                                                                                                                                                                                                        C
                                                                                                                                                                                                                 Samples received within
                SAMPLE IDENTIFICATION                             COLLECTION                             GRAB/        CONTAINERS                                                                                  24 hours of collection?           Yes
        *Use One Line Per Preservation & Container Type         DATE            TIME      MATRIX         COMP. Qty        SIZE & TYPE          PRESERVATIVE                                                      R       Condition      Split   LAB #
 1

 2

 3

 4

 5

 6

 7

 8

 9

10

11

12
MATRIX: Drinking Water (DW), Soil (S),               COMMENTS & SPECIAL INSTRUCTIONS:                                                                                                                                      CONDITION CODES
Waste Water (WW), Surface Water(SW),                                                                                                                                                                            1. Improper/damaged container/cap
Ground Water (GW), Solid Waste (WA),                                                                                                                                                                            2. Improper preservation
Sludge (U), Wipe (P) CONTAINER: 2oz,                                                                                                                                                                            3. Insufficient sample volume
4oz, 8oz, 40ml Vial, 500ml, Liter (L), Tube,                                                                                                                                                                    4. Headspace/air bubbles for VOCs
Glass (G), Plastic (P) PRESERVATIVE:                                                                                                                                                                            5. Received past holding time

H2SO4, HCl, HNO3, Methanol (MeOH)                                                                                                                                                                               6. Received frozen
NaOH, Sodium Bisulfate (NaB), NaThio                                                                                                                                                                            7. Label conflicts with COC
1. Relinquished By                                   Date        2. Relinquished By                           Date               3. Relinquished By                       Date             4. Relinquished By                           Date


Received By                                          Time        Received By                                  Time               Received By                              Time             Received By                                  Time
                                               Ice                                                      Ice                                                         Ice                                                           Ice

Submission of samples subject to Terms and Conditions on back.                                     Rev. 7/20/08                   Please fill out this form completely, print, sign & submit with samples. Keep a copy for your records.
                                                                                     Terms & Conditions
1. Submission of samples to Suburban Laboratories, Inc., herein referred to as              does not comply with this Sample Acceptance Policy (SAP), or if the COC is not
“SLI”, constitutes full acceptance of these terms and conditions unless otherwise           completed, a Documentation Preparation Fee may be assessed for each occurrence.
agreed to by both parties in writing. For each Chain of Custody Document (COC),             Data from any samples which do not meet the SAP will be qualified in an
Client will either provide SLI with the exact method references for analysis or will        unambiguous manner clearly defining the nature and substance of the variation.
identify the regulations under which analyses are to be prepared. When exact                8. SLI will retain samples for 45 days following the receipt. SLI will extend the
methods are not specified, Client agrees to hold SLI harmless from all claims,              retention period if Client so directs, for a fee. Following the retention period SLI will
damages, and expenses arising out of SLI’s discretion. Tests and observations will          dispose of or return samples to Client at Client's expense. Any samples for work that
be conducted using test methods as specified in accepted COC. If Client directs             is canceled or not accepted will be returned to Client at Client's expense. An Energy
SLI's to modify standard or recommended procedures, Client agrees to hold SLI               Surcharge will be assessed per workorder and a Sample Disposal Fee will be
harmless from all claims, damages, and expenses arising out of Client's direction.          assessed per sample as stated in SLI’s price quotation or according to SLI's then
2. SLI reserves the right to subcontract any portion of the services. SLI will notify       current fee schedule if there is no other written agreement as to price.
Client in writing prior to the subcontracting of any portion of the service.                9. SLI will notify Client promptly if SLI identifies any activity that SLI regards as a
3. SLI will furnish one electronic copy of each final report to Client. SLI will retain     change to the scope of the work, for which SLI may seek an equitable adjustment of
analytical data and reports for 5 years after final report date. Hard copies of reports     SLI’s compensation. Client shall respond to such notice promptly. Until agreement is
and extended document storage are available for a fee. SLI will agree to provide            reached concerning the proposed change, SLI may regard the situation as a
reports for Client's use only for the purposes disclosed to SLI at the time of              suspension directed by Client. If Client cancels the work, Client will be invoiced for all
contracting. Reports may not be reproduced, except in full, without the prior written       work performed prior to the receipt of a change in scope of work as indicated on an
approval of SLI. At SLI's sole discretion, “Preliminarily Results – Subject to Change”      Approval Form and as appropriate. If Client submits samples to be placed on hold
may be given in advance of the written report of results and shall satisfy turnaround       and never analyzed, a fee of $10.00 per hold sample will be assessed.
time (TAT) requirements.                                                                    10. Client agrees to pay for services as stated in SLI's price quotation or according to
4. TAT for routine samples is measured in working days and does not include                 SLI's then current fee schedule if there is no other written agreement as to price.
weekends or holidays. TAT calculations begin the day following receipt in the               Client agrees to pay invoices within 30 days of receipt. Client agrees to pay interest
laboratory, after resolution of any discrepancies or change to the scope of work. SLI       on unpaid balances beginning 31 days after receipt of invoice at the rate of 1.5% per
will make every reasonable effort to meet requested TAT. Acceptance of samples              month. Client agrees to compensate SLI for SLI's services and expenses, including
from Client does not constitute a Guarantee that results will be available within the       attorney and collection fees, if SLI is required to respond to legal process related to
TAT requested. Surcharges will apply to all rush orders. In those instances when            SLI's services for Client.
samples submitted for rush TAT exhibit unexpectedly high concentration of                   11. If Client does not pay for SLI's services as agreed; Client agrees that SLI may
contaminants which may require SLI to run multiple dilutions to comply with QC              withhold all work products not yet delivered to Client and that any discounts offered
requirements, the analysis requested may not be reported within the TAT requested.          will become null and void. Work products will only be released upon full payment of
Rush charges would still apply in these instances.                                          past due invoices at list price. Client also agrees SLI's work will not be used by Client
5. In order to meet method holding times and TAT, samples shall be submitted to             for any purpose whatsoever unless it is paid for in full in accordance herewith.
SLI immediately after collection. Samples with holding times of 48 hours to 14 days         12. None of SLI’s fees are guaranteed to be eligible for reimbursement by any party.
received with less than 75% of their holding time remaining will incur surcharges.
Samples requiring rush extraction due to holding times will be charged at a rate of         13. All laboratory and related services are subject to a minimum billing of $50.00.
50% the standard rush surcharge.                                                            14. SLI will not be liable to Client for special, incidental, consequential or punitive
6. Client shall notify SLI as to any samples that are suspected of containing               losses or damages, including but not limited to those arising from delay, loss of use,
hazardous substances. Under no circumstances will SLI accept delivery of samples            loss of profits or revenue, or the cost of capital. SLI will have no liability to Client for
containing levels of radioactivity. Regardless of a prior acceptance, SLI reserves          nonperformance caused in whole or in part by causes beyond SLI's reasonable
the right to refuse acceptance or revoke acceptance of any samples.                         control. Such causes include, but are not limited to, Acts of God, civil unrest, war,
                                                                                            labor unrest/strikes, power/equipment failures, analytical method limitations, matrix
7.     Samples submitted for regulatory compliance purposes must be (1)                     interferences, acts of authorities, and failures of subcontractors or vendors that could
accompanied by complete documentation, which shall include sample identification,           not be reasonably anticipated.
the location, date and time of collection, collector's name, preservative added,
sample type and any special remarks concerning the sample; (2) be properly                  15. The total liability of SLI, its employees officers, agents subcontractors and
labeled with durable labels and the use of indelible markings; (3) contain a unique         successors in interest for laboratory services is limited to the cost of the services
identification of the sample and each sample container that can be traced back to           provided. This clause supercedes all clauses contained in any client purchase order
field sampling records; (4) be accompanied by complete documentation of use of              or contract written or implied.
preservation and sample containers as required by the approved test methods; (5)            16. If it is claimed by Client or a third party that SLI did not complete an acceptable
adhere to the maximum allowable holding time prior to analyses as specified by the          analysis, under no circumstances will SLI's right to independently defend and gain
approved test methods; and (6) be of adequate size or volume to perform the                 acceptance of SLI's data be denied.                           Effective 07/20/08
necessary analyses. If SLI is required to contact Client regarding a sample that

				
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