Laserfiche WebLink
Q( <br />02 <br />03 <br />o� <br />Analytical <br />Laboratories CHAIN OF CUSTODY RECORD <br />Client: L iif F nPie y NOTES: <br />Contact: l n _a r T 1) Ensure proper container packaging. Table 1. — Matrix Type <br />Address: n 2) Ship samples promptly following collection 1 = Surface Water, 2 _ Ground Water <br />3) Designate Sample Reject Uisp <br />usition. 3 — SuilrSWiment, 4 = Prod.VU_, 5 — Oil <br />Phone Number tTQI ,3g� — 5 { 13O1+ G = Waste, " ° Other (Spec i fy) <br />Email: 1 3 -- Pmjeet Name: I11r 7 t Samplers Signature: <br />N <br />r <br />O <br />r <br />r <br />a� <br />Page__ <br />d <br />FOR Ci Al I s: - <br />GAL 1013 rs <br />Lab Nmue: Grain Analytical Laboratories (970) 247-4220 FAX (970) 24. -4227 <br />Analyses <br />Required <br />Address. 75 Suttle Street, Durango, CO 81303 www.greenanalytieal.coin <br />Collection <br />Miscellaneous <br />Preservatives) <br />Sample ID <br />Date <br />Time <br />a <br />_ <br />, <br />Comment" <br />3 <br />o <br />E <br />to <br />z <br />z <br />oin- <br />[4 <br />5. <br />6. <br />7. <br />8. <br />9. <br />10. <br />Rchnquished by: <br />Date: <br />Y',z5 <br />Timc t <br />:. <br />r <br />Received by ! <br />Da _ -_ <br />T' <br />Relinquished by: <br />Date: <br />Time: <br />Received by: <br />Date: <br />Time <br />Relinquished by <br />Date: <br />ITinte <br />Received by: <br />Dote: <br />Time: <br />' Sample Rejcct j• j Itelurn I I Uispo�e j i Store (30 Da\ s) <br />