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CHAIN OF CUSTODY RECORD # 00-00 <br />• ,~/~ AMERICAN <br />SODA, L.L.P. <br />SAMPLE ANALYSIS REQUEST FORM #00-020 <br /> <br />PAGE_7_OF_7~ <br />PROJECT: AMERICAN SODA, L L P. Please Address Analytical Reports, S Imolces to: <br />8lanketP.O. <br />PHONE # ; ENVIRONMENTAL ENGINEER: CELINA M. AKIN <br />~~~ L.ataratDry American Soda, L. L. P. <br />~: 2717 CourAy Rd 215 <br />Date Samples Sent Parachttte, CO 81635 <br /> Ext. <br />SITE DESIGNATION REQUESTED ANALYSIS PARAMETERS <br /> Please Analyze the enclosed samples (or the following parameters: <br /> <br />SHIPMENT CONTAINER CONTAINS <br />TOTAL SAMPLE BOTTLES <br /> <br /> Relinquished by. (Signature) Date /Time Received by. (Signature) <br /> Relinquished by: (Signature) Date /Time Received by: (Signature) <br /> Method of Shipment: HAND DELIVERED Daze Shipped: Shipped by; (Signature) <br /> Cootie. (Siguwture) Received for laboratory by: Date /Tune <br /> (Sigwture) <br />Dirtrihualon: Original COC Acconepanln Shipuent; Return signed arig_d COC to AMERIC:9N SUVA, !.L P. (strove <br />address), <br />Were Satrtptes Received la Good CandibonP Ye No Snunples on /ceP Yts No Method ojShlpunent <br />Were the analyses requited on the Chain ojCustody reportedP Yes No Ijno, what analyses are sdU needed? <br />Was the report issued wkhin the requested ntrnaround ante? Yes No Pjna, what was the tarnaround rhneP <br />Approved by: Signahure: Company: Date: <br />C:\Laboratory\SampleslSARF\FEB00. DOC <br />