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Analytical <br />Laboratories, i~~. <br />Client <br />Contact: ~` ~ (~ - <br />Address: :~-, - t: <br />Phone Number: ,~ ~'~ •- C'7 <br />FAX Number: I UFT?='-7 ,t•-r.~ ~ <br />CHAIN OF CUSTODY RECORD <br />NOTES: <br />1) Ensure proper container packaging. <br />2) Ship samples promptly following collection. <br />3) Designate Sample Reject Disposition. <br />PO# <br />Project Name: ~~ ~ r ~tiL (_~.~ <br />Table 1. -Matrix Type <br />1 =Surface Wa[er, 2 =Ground Water <br />3 = SoiUSediment, 4 = Rinsate, 5 = Oi] <br />6 =Waste, 7 =Other (Specify) <br />Page_ of <br />FOR GAL USE ONLY <br />GAL ]OB # <br />."~7 2-r5 <br />Lab Name: Green Analytical Laboratories, Inc. (970) 247-4220 FAX (970) 247-4227 A lyses Required <br />Address: 75 Suttle Street, Durango, CO 81303 <br /> Colle ction Miscell aneous Pre serv ative (s) <br /> ~ T <br /> _ >" O <br /> 4 <br />~ C. <br />~ ~ <br />u <br /> <br />Sample ID <br />Dato <br />Time <br />>, <br />~ -' C <br />'ro N <br />~ v <br />a T <br />~ <br />Comments <br /> ~ a?r <br />F c = <br />k ~ y <br />c> <br /> d <br /> <br />- F <br /> <br />~~ t j <br /> <br />o . <br />~ ~ <br /> <br />O <br />a <br /> <br />O vv <br />i <br /> . <br /> <br />u E <br />~ o <br />` <br /> <br />Z a <br />E <br />m Q, <br /> <br />~ <br /> <br />x a <br /> <br />V ~ <br /> <br />x <br /> <br />z ~ <br />s <br />O <br /> ~ w P <br />T, <br /> <br />~' ' v2 t. " L"~ C-~ <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />10. <br />RelingUlsheA by'. Da , Ti Received by: 7 Time:. „ <br /> <br />Relinquished 6y: Date: Time: Received by: ~ _ Date: Time: <br />~i <br />U <br />* Sample Reject: (]Return [ ]Dispose [)Store (30 Days) <br />