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
TURNAROUND TIME REQUESTED ANALYSIS & METHOD REQUESTED
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
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
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 #
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