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<br />CHAIN-OF-CUSTODY FORM <br />CLIENT ~7"iI_f~°~_Ln~~ w~C.f,y `,~:;L~,~~L <br />ADDRESS ?~' `-, Z7,: N, ~-, ~, <br />.~ Ova-rbr.a r"~. ~~;y'`3;:: <br />PHONE ~ t~-~ -~`;i?~r FAX ~ ~ :?~~-7 <br />PROJECT <~ :: , ~ P ,~.# ; ~ 1 <br />SAMPLER'S SIGNATURE <br />i .~ <br />Enviro-Chem Analytical, Inc. <br />685 West Gunnison Avenue <br />Suite 108 <br />Gzand Junction, CO 81505-7249 <br />(970) 242-6154 phone <br />(970) 245-9270 fax <br /> <br />;Y ~' <br />` ,. . <br />l~l, ie <br /> <br /> <br />Sample <br />Sample t <br />Anatysis~ f Pio, of <br />Sample LD. Date/Time Location ~S` ,x-, ' , ~` ra ~~' -= ~ E ~ •~ /Containers <br />1 <br /> ~~ <br /> <br /> ~; <br /> <br />Aqq <br />tVl ~_. ~!, <br />t~.;`.;1 i'n's / ~; <br />fn.~~i..~ ~ <br />~ <br />f <br /> <br /> <br /> _:!- <br /> <br /> <br /> .y ~_. ;~. <br />i .. <br /> i.• ~h.,_ <br /> <br /> ,, <br />" ." <br />Relinquished By: - r~'~=,.~~~ ~ Accepted Bq: '~~ <br />Date/Time !r.., ~-r-;°' a.~;'.t.,:,., Date/Time '' . `.~ r. =i , • .; <br />Relinquished By: Accepted By: <br />Date/Time Date/Time <br />FOR LAB USE.ONLY <br />Seals Intact: YES' NO <br />Received in Goad Condition <br />Special instructions: <br />Preserved Property: YES NO <br />How <br />YE5% NO Adequate Sample Received: YES NO <br />Holding Time Met: YF.S NO <br />Delivered 13y: HAND USPS FedEx <br />UPS Other <br />