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<br />CHAIN-OF-CUSTODY FORM <br />NT f {1-: ~_ ~} ,..5. fu`C. - ~../C='% /c1 :r :yj ,r~.`a'r{C E.. <br />ADDRESS _ ~" -~ jz;, r ~, h <br /> <br />PHONE ' ~ `~"7 - .~': bt FAX 4 ; ~ '~ ~, 9 7 <br />PROJECT ,+-,•, ~P .da ; ~ t <br />SAMPLER'S SIGNATURE <br />C` , ~` "S RI's j'.. \'~~C <br />`F? <br />. . <br />Enviro-Chem Analytical, Inc. <br />685 West Gunnison Avenue <br />Suite 108 <br />Grand Junction, CO 81505-7249 <br />{970) 242-6154 phone <br />(970) 245-9270 fax <br />F <br />'. /r in r, <br />J 4,- ''l'.i f~ <br />' ~~~ ~ ~ <br /> Sample Sample Aualysts~ / I~J'o, of <br />Sample LD. Date/Time Location `vti r . ~` = ; ' 'i'~ ` `Containers <br />C' ~~ <br /> , <br /> <br /> <br /> ir~~-.. ,~"~ . <br /> ,.. <br />f+ <br />e <br /> ,u. ~ (r,', ..:,~, <br />~tt tt <br /> IC' ~ j'S1 ~> <br /> +P~ <br />I C.L.. <br /> <br /> <br /> ra. ae. ~>~.: <br /> S_~~i~,".cE' <br /> <br />Relinquished By: , -.-y -= ~'•~ . - ~ Accepted By: r ~ ~ i =w <br />F <br />Date/ISme !~-?~ ,^.~° s.~v•~",:>r,~~ Date/Time ~ %,~ ~~ =.::~; ~ <br />Relinquished By: Accepted By: <br />Date/Time Date(Time <br />FOR LAB USE.ONLY <br />Seals Intad:' YES' NO <br />Received in Good Condition: YESI NO <br />Special Instructions: _ <br />Preserved Properly:: YES NO <br />How <br />Adequate Sample Received: YES NO <br />Holding Time Met: YES NO <br />Delivered By: HAND USPS FedEx <br />UPS Other <br />