Laserfiche WebLink
CHAIN OF CUSTODY RECORD Laboratory Sample Numbers (ACZ Use Only): ~ ~ ~ ~ /_' ~ <br />/ cpc ~ 1536,3 <br /> <br />~~ Leboratorles, Inc. <br />30400 Downhill DrNe <br /> <br />Steamboat Springs, CO 80487 <br />(970) 879590 • (800) 334-5493 - (Invoice) to: (circle one or both) <br />Name to Appear on Repoli and Invoice: cc (Repo <br />~~er~„~ /~~:,,.:. G~. ~ <br />~5?l G/,~n....a S~r~, f rs c ~ <br />~'~ ~'r'~N~/~r~, !~ 9y/ofr !' ' <br />Attn:~,s„• hex el:y,~ q,~3.~j,~ Attn: el: <br /> <br />ProJector <br />P.O. N z(pg A NALY SES REQU ESTE D <br />~~ <br />lst~de /7.., a <br />(ru~ , f0 ~/I?O ~ <br />a REMARKS <br />Shipped Via: FED X_,.U,~S_Hand_Other $ ~ r <br />SAMPLE IDENTIFICATION : DATE TIME Ssm e ~ <br />_ <br />/0 4 <br />O <br /> o Zlo <br /> <br /> <br /> JF <br />:~ <br /> ..ice :~ ---tc.. <br /> <br /> ~~ <br /> <br />• Meubr OpWns: sw (Sudea wstar) • ow (c3roura water • W W (Wastsweter) • ~w (DAnklnp wats~ • SL (Sluepe) • 6011. • olL • OVrsr (SpeClfy) COMMENTS <br /> <br />SAMPLE DISPOSAL OPI7BNS - P/esae eomprsts ssetlort A, or choose one opflon riom sections BAND C. <br />Proper eharyss wrll be asessasd. // <br />~ p(rj ~„ ~ ~ Ssi~is~ <br />To ; <br />(A) Long-Nrm atoraps <br />Hold until (dale) <br />for future analysis. (B) N Samprs Is Non-Hazardous <br />t) Local Disposal <br />2) RCRA -Permitted Facility <br />3) Return to Client (C)1/ Sample !s Hazardous <br />t) RCRA-Permitted Facility <br />~ Retum to Client <br />RELINQUISHED BY: (SIGNATUR E) E <br />DAT TIME RECEIV BY: (S IGNATURE) DATE TIME PAGE p <br /> e <br /> O <br />F <br /> / <br />-__[__ <br />White • Return w/ sample Yellow - ReWrn w/ sample Pmk -Rehm w/ sample Gold -Keep for your records <br />