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CHAIN-OF-CUSTODY FORM <br />CLIENT r'?dun~,,, ,~ Cou,( G4 <br />ADDRESS P. o, gax v 9 l• 5 t ?y <br />PHON~97a~ 9a9-~a3S FA~ ~~~ qa9-~559~ <br />PROTECT 1~/esT E!K /~'~,'nP/ <br />SAMPLER'S SIGNATU <br />~~~~~~ <br />Enviro-Chem Analytical, Inc. <br />685 West Gunnison Avenue <br />Suite 108 <br />Grand Juncrion, CO 81505-7249 <br />(970) 242-6154 phone <br />(970) 245-9270 fax <br /> <br /> <br />Sample I.D. Sample <br />Date/Time Sample <br />Location Analysis No. of <br />Containers <br />Q 17 ~ l6 0 <br />S•'Sd Awl <br />d~sch0.+ ~. <br /> <br />Q l7 /_ /6.0-7 <br />~'`t5/rwl <br />ci!~~sc~ar Z. <br />e2 <br />D <br />7 <br />u~ ~ pN 8 iq <br />TtM ~p~yc <br /> /- /~- D 7 h ~ ~` v `a P H 8,37 <br /> <br /> <br /> <br />Relinquish Accepted <br />Date/Time ate/Timf <br />Relinquish Accepted <br />Date/Time/'/~~ ~~ ~.3~ /~NI Date/Time <br />FOR LAB US <br />Seals Intact: O <br />Received ' nditi NO <br />Special Ir~sttuctions: <br />ed By: <br />/-/~ 0 7 /D= 5'S a rat. D <br />ed By: CCcz' ~/ <br />Preserved <br />Adequate San <br />Holding Time <br />Delivered By: <br />NO <br />USPS FedEx <br />Other <br />