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Chain of(.___ody Form qk� colorao" <br /> Andyfi al <br /> Tntac <br /> To taierrutation t3iM To Information(li•dii!'errnt fmm reort to) Project Name LABORATORIES,uvc <br /> ay I�iatae: 'WYf tit 9t' Conzprny N:tee: � 1V11Briehfou Lat Name. 1i. Coetact Name: 240 South Main Street <br /> Brighton,CO$0601 <br /> All <br /> dress: j S� Address: Task Number(Lab Use Only) Lakewood Lab <br /> 12860 W.Cedar Dr,Suite I00A <br /> _ 150616081 Lakv#ood CO 9M8 <br /> Stale tb 2.p wq w city Sate Zip RNL Phone:303-659-23I3 <br /> Fax:303-659-2315 <br /> P one-72DMbignPar: 30S-T8Z,661D Phone: Fax: www.caloradolab.com <br /> Bmait: ` Email: 5ampk Disp.DateEl abUsc Only) <br /> Sam ler Name: 1 PO No.: <br /> Satople Matrix Select One On1 <br /> aste Water ❑ Soil ❑ Plant Timm ❑ <br /> round Water❑ Sludge ❑ Other ❑ p <br /> S I rface Water Compost ❑ w <br /> o _ <br /> D Time Sample 1D z° `oLai I I I I I I I I I 1 1 <br /> X <br /> Instructions: GS Life: Sab Preseaf Yes El No <br /> DNher Vta; 0S CAMM El T /. Sam Peer.YnQ No <br /> RelIquished. Date/Time: R y: Relinquished By: Date/Time: Received By:I DatelMme: <br /> &11 Iz <br />