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DI <br />D.� <br />�3 <br />b� <br />Analytical <br />Laboratories <br />Client: '1 <br />Contact: <br />Address: <br />13J lb <br />Phone Number: r��) <br />Email: <br />CHAIN OF CUSTODY RECORD <br />NOTES: <br />1) Ensure proper container packaging. Table 1. — Matrix Type <br />2) Ship samples promptly following collection. 1 = Surface Water, 2 = Ground Water <br />3) Designate Sample Reject Disposition. 3 = Soil/Sediment, 4 = Prod.W., 5 = Oil <br />PO# 1 6 = Waste, 7 = Other (Specify) _ <br />Project Name: K. 1-d Samplers Si <br />Page of _ <br />FOR GAL USE ONLY <br />GAL JOB # <br />t M'� <br />Lab Name: Green Analytical Laboratories (970) 247 -4220 FA (970) 47 -4227 <br />Analyses Required1 <br />Address: 75 Suttic Street, Durango, CO 81303 www.greenaiialytical.com <br />3 e C" <br />Collection <br />Miscellaneous <br />Preservative(s) <br />dV) I�_2 <br />v <br />� <br />� <br />Sample 1D <br />Date <br />Time <br />°? <br />Comments <br />t=' � <br />° <br />ii <br />f✓ <br />� <br />° <br />n <br />O <br />O <br />U <br />Ci <br />Z <br />x <br />2 <br />Z <br />O <br />�. <br />4, <br />b< <br />4. <br />_ tl., <br />C <br />11 <br />�l <br />x <br />Ja <br />5. <br />6. <br />7. <br />A. <br />9. <br />10. <br />Relinquished by: <br />Date: ` f <br />/ <br />TimeZi <br />Received by: <br />Date: <br />3 <br />Tirpe, <br />/ <br />�J <br />^ ! <br />S <br />Relinquished by: <br />Date: <br />Tim e: <br />Received by: <br />Date: <br />Time: <br />Relinquished by: <br />Date: <br />Time: <br />Received by: <br />Date: <br />Time: <br />• Sample Reject: ( ] Return I j Dispose I i Store (30 Dais) <br />N <br />O <br />O <br />rn <br />a co <br />