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Inter- Mountain <br />laboratories, Inc. ~-~'~~ <br />CHAIN OF CUSTODY RECORD <br /> <br />:~ <br />Clf nt/ProJect N e <br />JD~iI! ~ Project Location <br />~JJ~,~j~~~ ~~ //~CA~ <br />ANALYSES /PARAMETERS <br />Samp~(Signature) Chain of Custody Tape No- <br />e <br />c ~~ <br />P <br />Sample No.l c o ~ ~4 <br />Identification Date Time Lab Number Matrix ZO `~ <br />Remarks <br />q.,~t~ ~ 1 9 /~ ~~' 331 Z ~JQTcK j <br />~ g/ /~ ~ 331 ti 4'fc..~ I K <br /> t 20•A'! <br /> z <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Relinquished by: (Signature) <br />-~~~ ,~:.~ ~ 8 <br />oa Date <br />~l Time <br />~~ Rece by: (Sig 4ture) Date Time <br />Relinq/u//i/sh~ed by: SignatuJre)/~ Date Time Received by: (Signature) Date Time <br />Relinquished by: Signature) ~ <br />~ [~/n ®7T d1Le-dFT t <jsl.l~ Date Tlme Received I re o : (Sign re) <br />(' Date <br />, ~ pL Time <br />~(j~, S ~/ <br />~~~~/~ ~ ~-~ Inter-Mountain Laboratories, Inc. <br />555 Absaraka 1633 Terra Avenue 1701 Phillips Circle 2506 West Main Street <br />Sheridan, Wyoming 82801 Sheridan, Wyoming 82801 Gillette, Wyoming 82718 Farmington, NM 87401 <br />Telephone {307) 674-7506 Telephone (307) 672-8945 Telephone (307) 682-8945 Telephone (505) 326-4737 <br />11183 State Hwy. 30 <br />College Station, TX 77845 <br />Telephone (979) 776-8945 <br />G <br />C <br />