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-�aceAnalytical Pace Analytical Services, LLC - CHAIN OF CUSTODY RECORD - Page of <br /> All shaded fields must be completed. # 194199 <br /> Sheridan,WY and Gillette,WY This is a legal document:any misrepresentation may be construed as fraud <br /> Client Name Project Identification Sampler(Signature/Attestation of Authenticity) Telephone# <br /> k,-\t A-C�k C)') . \ V I u <br /> Report Address contact Name ANALYSES/PARAMETERS <br /> Email <br /> Invoice Address Phone <br /> Purchase.Order# Ouote# <br /> REMARKS <br /> w LAB ID DATE I TIME SAMPLE nor <br /> (Lab Use Only) SAMPLED IDENTIFICATION Matrix Containers <br /> 1a?oaior-v.i 1g2 'C" 2O-Z2- W V7� ki�v wN C� T I �( sz3o��y� , <br /> qDT <br /> S �.l <br /> 0, 7 <br /> CODESSHIPPING INFO MATRIX <br /> . . ADDITIONAL <br /> IJ UPS Water WT Check desired service Compliance Monitoring? Y/N <br /> U Fed Express Sod SL U Standard turnaround Program (SDWA, NPDES,...) <br /> U US Mail Solid SD U RUSH -5 Working Days PWSID/Permit# <br /> i_J Hand Carried Filter FT J URGENT-<2 Working Days Chlorinated? Y/N <br /> U Other -_ __. Other OT Rush&Urgent Surcharges will be applied Sample Disposal: Lab Client <br /> n...._ n�,......... ems_.,.___ i.r ,..,..,.....,....i..ti........, n_.. �- <br />