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Analytical <br />Laboratories <br />CHAIN OF CUSTODY RECORD <br />Client {-v r P,,n o i NOTES: <br />Contact: �U� l�irLDd <br />Address: (:� L( 73 C9 12 <br />Phone Number: <br />Email: <br />I ) Ensure proper container packaging. <br />2) Ship samples promptly tbllowing collection. <br />3) Designate Sample Reject Disposition. <br />PO# <br />Table 1. - Matrix Type <br />I = Surface Water, 2 = Ground Water <br />3 - Soil /Sediment, 4 = Prod. W.. 5 = Oil <br />6 = Waste, 7 = Other (Specify) __ _ <br />Project Name: k1 ,141 , - Samplers S <br />tit - L o ! „ n\ /7 <br />Lab Name: Green Analytical Laboratories (970) 247 -4220 FAX (970) 247 - <br />N <br />r <br />Analyses Required <br />O <br />Page - of' - — <br />N <br />d <br />I -(1R GAt. UM ONIN <br />GAL JOB # <br />OC- <br />Lab Name: Green Analytical Laboratories (970) 247 -4220 FAX (970) 247 - <br />227 <br />Analyses Required <br />, <br />_ <br />Address: 75 Suttle Street, Durango, CO 81303 www.greeilanalytical.com <br />OC- <br />Collection <br />Miscellaneous <br />Preservative(s) <br />T <br />\ <br />L <br />Sample ID <br />Date <br />Time <br />L <br />? <br />v <br />:l <br />y <br />Comments <br />v <br />f <br />b E <br />a <br />a <br />Z <br />O <br />L <br />ti. <br />z <br />ViG <br />= <br />W <br />Z <br />C <br />% <br />In <br />61 <br />1' <br />ti <br />t <br />Kin <br />AL <br />5. <br />b. <br />7 <br />r. <br />ItI. <br />Relinquished by: <br />Date <br />Ti ., e�� <br />Received by: <br />Date. <br />Time: <br />(p <br />t 7-5 <br />Relinquished by: <br />Date: <br />Time:' <br />Received by: <br />Date: <br />Time: <br />Relinquished by: <br />Date: <br />Time: <br />Received by: <br />Date: <br />Time: <br />* Sample Reject: I I Return I I Dispose 1 I Store (30 Days) <br />