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CHAIN-OF-CUSTODY AND ANALYSIS REQUEST <br /> An�3lytieal (970)247-4220 service@greenanalyticai.com or dzufelt@greenanalyticai com <br /> Fax:(970)247-4227 75 Suttle St Durango,CO 81303 <br /> Company or Client: <br /> 777 Se___ ' nt n _7_-�_(.,' ._.._ Bill to(itdtitrrt�nt): ANALYSIS REQUEST <br /> Address: 3 q z jP /�� ,..,�IQ.f�� to � P.O.r;. --- - , <br /> --- <br /> City_ -- SL"Cl�/�� — _ State: 00 Zip: company: RZ 1n�*or;���,'e <br /> Phone#: - �z Q = '{� '_? — nun: AporneRO 6113w <br /> IzS <br /> Contact Person: �"f� `� �- <br /> -- -- �PUr'G.P ! U�7l /IsOr7 Adtiretis: <br /> Email Report to: Of7 (3_,.t^ i/7(1 <br /> ��JJ JJ _ <br /> pr lcrtNantL{uptuln•tl)` 30� - 7�U k9zs_ ci,/'O, (-rft AQ,t- Statc -- /11) VD <br /> I,'nr is-S 0 r'l,am6117cllq ll Farms ow_...- <br /> Sampler Name(Print): t:mafi: <br /> Collected Matrix(check on #of containers <br /> — - 3 <br /> i W m <br /> W w d <br /> Q WS <br /> For Lab Use Sample Name or Location o 3 uJ <br /> Jo <br /> = Q J Z = 10 tDate Time cn a � 0 O z x x = O O_—. - - z 2- c X - -- - <br /> D3 yo Pal <br /> 6S- fV -- <br /> - - <br /> -- ----- 211 <br /> PLEASE NOTE: kablhry and is exclusive remedy for any claim ansing whether based m contract or tort shall be limited to the amount paid by the client for the analyses All clams including those for negligence and any other cause whatsoevef shall be doomed waived unless made m wubng and receiver <br /> try GAL within days tier co n In no even:shall GAL be liable for incidental or consequental damages,including without limitation business mterruphons,loss of use,or loss of profits incurred by client as subs,Marles,affiliates or successors ailing out of or related to the performance of services hereunder <br /> GAL re helh rch claim s based u an of the above stated reasons or otherwise <br /> @ In 5 Dat c)" cp \ ? 2 ��t . <br /> v 1'r�• N�� <br /> ,nr r113 n ------- —�Hair Ito a►��: - - !lo Sama L2 <br /> c�ti a `maa�r� ;t -t� b62J1� -S aS area comas c� J� <br /> f <br /> I <br /> I <br /> I inn• -- - — <br /> R0linclul�h_et l 13v i 11.u1• I IZereIvcc1 13v' <br /> ! frinl�crattn<•,vl�•,rli,t fall•t:Kk•.bv1 <br /> t GAL cannot always accept verbal changes.Please fax or email written change requests. <br /> Chain of Custody must be signed in"Reliquished By:"as an acceptance of services and all applicable charges. Just Click Pfmung Fam#1r-0301 <br />