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CHAIN-OF-CUSTODY RECORD AND REQUEST FOR ANALYSIS <br /> 41823 <br /> MCCULLEY, FRICK & GILMAN, INC. COC No. <br />~ROUltler OB¢e ^ Missoula OB~rc ^ <br />` <br />" Osborn OMim ^ San Francisco OB¢e ^ Sarna Ana OB¢e ^ Seattle Oe¢e ^ <br />' <br /><900 Pearl E. Girlie 2s5 5 3 <br />51 Wesl <br />SWe a300W Missoua MT 59801 Avenue W <br />809 E. Mullan Avenue T1 Stevenson Si 41450 640 NoM Tustin Ave. 19]03 36 <br />Osborn ID 03849 San Fra~ose0. CA 9A105 $m1e 101 Suae pt Ot <br />eouMer. CO 80301 TEL (9081 T28<600 TEL (208)SS6EB11 TEL 1d15)a95~T110 $anlaAM CA 92]05 Lynnwootl. WA 98038 <br />TEl (303)40-1813 FAX (<O6)J28<69B FA% (2p8)556J2J1 FA% (415)<95-Jt OJ TEL 014)9]33090 TEL (<251 ]J8~8]52 <br />FA%(3031 ad]-1836 FqX Q14)9T3-b9T Fq%(@5))TtEBC2 <br />PROJECT NO. 5"y(o~ - JECT NAME: I ~ ~+Ft2 \9`t9 GOLD HILL HrIL Sft'~PLII.S~ PAGE: 1 OF: J <br />SAMPLER (Signature): PROJECT MANAGER: "furl EQtE1k.WrJ~/~ip.Z!` ~1,iAfrx>..1DATE: ~2S~g9 <br />METHOD OF SHIPMENT: c CARRIERNVAYBILL NO.: DESTINATION: t-fnZE.f3 t A~ <br />ToM LLl=JJ <br /> SAMPLES ANALYSIS REQUEST <br /> Sample Preservation Containers ConstituentstMethod Handling Remarks <br /> z <br />o <br />,L o <br />a <br />Field <br />~ <br />" <br />° ¢ ~ N <br />~ ~ <br />Sample ;, ~ o ° ~ ° a ~ N ¢ <br />Identification DATE TIME ~ _ _ _ ~ LL E ~ Z o ~ ~ <br /> <br />wwuewiA ,zs 9 ~0 2 3 1 P ~ sEtL~'R£v OJS <br />wFU t~ - ~o0 3 ~ 3 usr of <br />wEU.;* Z.A 5 2 \ 3 Y'r~s <br />wELL *-. 2 ~~2b 2 3 <br />wEL,L ~ 3 1150 Z 3 \ 3 <br />WELL ~4 I~1a Z 3 3 <br />LEL A Sri ~ 2 '~ \ 3 <br /> <br />LF_FTt-IRN~ ~. i6.20 2 3 \ 3 <br /> <br />~aNo 1~ z 1 <br /> <br />~.~~~ .... .. ..~~~~~. ~.~. .~~ ~ <br />:. <br /> <br />:.:' . OTAL NUMBER OF CONTAINERS BORATORY MMENT ITION L <br />RELINQUISHED BY: RECEIVED BY: <br />SIG TURE PRINTED NAME COMPANY DATE TIME SIGNATURE PRINTED NAME COMPANY <br /> r ~K~ STr-EPSON ?5 5"i 1 X30 ,S /~'i~~ <br /> <br /> <br /> <br /> <br />gEy Marm AO ~ apvom NA ~ rwWroui 4iyp {e4okixn A ~ as OI ~ dM' Codaircn. P-P'a4c L ~ you T . lelbn 9 ~ baaa OT ~ doer F.1rYUn' F ~TfdM 0. uWaM <br />50 ~ ao/ SL , a P <br /> IXSTMBMOM: NMe FM Copy YELLOW Eab'Ndy CePy MHIiE' Pe/vn to pgnya <br />u <br /> <br />