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&AnsIVIticaw CHAIN OF CUSTODY RECORD Page of <br /> Laboretorbs,me <br /> I <br /> Client `Cl Cam-; K"t tYt NOTES: <br /> Contact .�d vZ �� v S 6, })Ensure proper container packaging. a e 1.—Matrix Type <br /> FOR CAL JSEovtY <br /> Address: 34t`b 4--cr S Sf- 2) Ship samples promptly foilow'sng collection. 1 =Surface Water, 2=Ground Water <br /> GAL 3013# <br /> G 92 1' 3)Designate Sample Reject Disposition. 3=Soil/Sediment, 4=I2insate, 5=Oil / Z_ f� <br /> Phone Number. Olhei(SQecifj -.-- <br /> FAX Number. Project Name: Samplers Signature: <br /> Lab Name: Green Analytical Laboratories.Inc. (970) 247-4220 FAX(970) 247-4227 Analyses Required <br /> Address: 75 Suttle Street, Durango, CO 81303 �I <br /> Collection Miscellaneous Preservative(s) ti <br /> Sample 3D Date Time <br /> n VI) Comments <br /> -E a i� <br /> 2. _ 2 <br /> s <br /> II, J <br /> 16. <br /> 7 <br /> 9. <br /> Relinquished Date: "Time: Received by: <br /> — Date- Time: <br /> Relinquished by: Bate: Time: Received bv: Ti <br /> 'Sample Reject:[ )Return [ J Dispose J J Store(30 Days) ;4 <br />