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<br />ANALYTICA <br />ENVIRONMEN"1'AL <br />LABORATORIES <br />-+__ mil, ~T:T .c.~.+4+...._.~.~.~... ....-. i. <br />f +.~ <br />12189 Pennsylvania Street <br />Thornton, CO 80241 <br />(303)469-8868 or1-800-873-8707 <br />CHAIN OF CUSTODY RECORD Faz: (303) 469-5254 <br />CLIENT NAME <br /> <br />!0/6 ~rY ~ .~I, K ~ li ~ d ~ CLIENT CONTACT <br />Q <br />P rdx (~. l~/a /f * Y~ ANALYT ICA <br />USE ONLY <br />~1(r ~ 3~ ~ S <br />Z~ S~ <br />CLIENT ADD ESS Sy kw <br />~' PR CT ID/DESCRIPTION <br />1 <br />P ~~ <br />/3 /3 s <br />~l.H.I~•r~Cd BdLO3 ~~'tK c- 3i-~ Zs <br />csN ~~7zy~ <br /> <br />TELEPHONE ~a3 8` L y9 /Q <br />LGN ' / <br /> <br />FA% <br />P. O. NO. <br />TESTS REQUESTED I <br />[ ~ Z <br />~ <br /> ~ , <br />LOC "`~~ <br /> <br />atrix (circle one) <br />ATER SOIL OIL SLUDGE <br /> <br />No <br />~ <br />"~ <br />~ <br />)c.l _ <br /> <br />oc <br /> <br />OTFiER (specily) <br /> <br />i <br />BOTTLES <br /> <br />h <br />~ <br />V <br />p <br />0 ~//n~f'^_ p <br />PM ~- <br />(NOTE: use one Chain of Custody per ma tr <br />x) <br />G q. ^^ \\ <br />DATE TIME CLIENT ID ~ Vl DUE / ' / V !N <br /> <br />fit: Pr- / .4 ~.~; ~ , u <br /> <br /> ~~i ~ <br />T <br />P wf~~~ ~ ~ <br /> ~ <br />} ~/ ~/ ~/ <br /> _F. <br /> {r J <br /> \ f~ f M ~ [J ZV~ <br />~ <br />t <br /> <br />s~1 <br /> <br />- <br />"h <br />. r .. <br /> ~ ~ <br /> t - <br /> <br />COMMENTS ~ ^5;.s. ~ MEANS OF DELIVERY <br />RELINOU HED BYf DAT E/TIME RECEI ~ DAT E/TIME REIINOUISHED BV OP.TE/TIME RECEIVED BV DA IE/TIME <br />.~,~ ~~~. <br />.- --, - <br />-.~ - <br />- <br /> <br />`} M <br />aE <br />