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Ana ical <br />Laboratories <br />CHAIN OF CUSTODY RECORD <br />Client: (M��r' �! P NOTES: <br />Contact:. <br />Address: (117 3 e e oo <br />Phone Nu(mb�e7r,� 3 j } (A1 <br />Ftnail: LC ,6) mm- %-:�q <br />I.) Ensure proper container packaging. <br />2) Ship samples promptly following collection. <br />3) Designate Sample Reject Disposition_ <br />PO# <br />�►t+ ..�jl 'Kim <br />ilr� <br />Table 1. — Matrix Type <br />1 = Surlace Water, 2 = Ground Water <br />3 = SoillSediment, 4 = Prod.W., 5 _ Oil <br />6 = Waste, 7 = Other (Specily) <br />Pagc-4- of 1 <br />I- uR GAL 111{ -. 4 ALl' <br />GAL JOB # <br />I x(03- 2yb <br />Lab Name. Green Analytical Laboratories (970) 247 -4220 FAX (97017474221 <br />Analyses <br />Required <br />0 L <br />Address: 75 Suttle Street. Durango, CO 81303 www.greenanalytical.com <br />Collection <br />Misccllawous <br />Prescrvativc(s) <br />0,\ �— <br />c <br />Sample ID <br />Date <br />Time <br />>, <br />— <br />c <br />a <br />Comments <br />i <br />o <br />0 <br />2. <br />S. <br />b. <br />7. <br />g. <br />9. <br />10. <br />Relinquished by: i <br />Date: Zg _ <br />Time x <br />Rectived by: <br />D <br />TL Y 1a <br />Rel*uished by: <br />Date: <br />Time: <br />Reorived by: <br />Date: <br />Time: <br />Retinquished by <br />Date: <br />'rime: <br />Roccivcd by: <br />Date: <br />Time: <br />* Sample Reject: [ ] Return [ I Dispose [ ] Store (30 DaNs) <br />N <br />O <br />N <br />m <br />M <br />a. <br />