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CHAIN OF CUSTODY RECORD Laboratory Sample Numbers (ACZ Use Only): n) z <br />~/ / ~~ ~ J coC a 02612 <br />A <br />Laboratories, Inc. <br />2773 Dovmhlll DrNe <br />Steamboat Springs, CO 804 <br />(970) 879-8590 • (800) 334.5493 Name to App ar on apart and Invoice:. cc: (Report) - (Invoice) to; (circle one or both) <br />~ Q <br />S E R <br />~ ~ M~ urr r• a I() <br />Attn: ,} I • el: q7 ~ y o4ttn: el: <br />Projector P.O. q A NALY SES REQU ESTE D <br />// <br />~~z. ~6~b~. ~~~ W <br />~ ~ <br />tP 2 <br />R t't- <br />~ <br />`~ ~ ~ <br />~ r( r{ <br />N ~ ~ <br />~ H <br />8 ~ REMARKS <br />Shipped Via: FED X_ UPS_Hand_Other o ~ g ~ ~ t~ ~ { o h ~ `~ <br />` <br />SAMPLE IDENTIFICATION DATE TIME M9mPle ~ ~ ~ ~ ~~ ~ ~~ <br />9 071 Jl6tr I~: ~ Lt! X h x ~ x K S C <br />I$ 0 A(w~ ~rr. S k ~ ~C sr k u '~ ~° e <br />Mw3 I: '< k ~ x x '~ / <br />Mw 1:4s 5 u k u x x <br /> <br /> <br /> <br /> <br /> <br /> <br />• McCEt Optforo: SW (Sudece water) • GW (Ground wafer) • YJVd (We~teweter) • DW (Drinking water) • SL (Sludge) • SOIL • OIL • Other (Specly) (`~ ENTS r <br />~ r ~.1 <br />Le C <br />l~o~ <br />; <br />SAMPLE DISPOSAL OPTIONS - P/eaae complete aectlon A, or choose one option from sect/ons BAND C. <br />Proper charges w1/1 be asaeaaed. , <br />M7~~ <br />„ <br />~ <br />~T4'3, [p~ 1fp ~;~~r a,,,o/ p~,~ ~r~ • <br />r <br />(A) Long-term storage <br />Hold until, ~Z-S/-A~ (date) <br />for future anaysls. (B) ft Sample le Non-Hazardous <br />1) Local Disposal <br />2) flCRA • Pormitted Facility <br />u) RHIUlO iU Nleni (C) if Sample is Hazardous <br />1) RCRA-Permiried Facility <br />2j Return to Client C~~ 5 ~ / T/J ~J <br />// pp p - ~ ,/ F 2 M <br />ZAP R ~G r. ISn J ./t ~ , /~ N .. <br />- r "" ~ ~"'/~' / - / ° I ~ .. ~ 1 / r I <br />C <br />RELINQUISHED BY: (SIGNATUR E) DATE TIME R <br />ECEIVED BY: (S IGNATURE) DATE TIME PAGE a <br /> -' I ~" r <br />r a ~ 7 Ib <br /> <br />- OF <br /> 2. ~rll lot, <br />D Whtte -return w/ sample tallow - r+aturn w/ sample rink - lieturn w/ sample Gold .Keep for your records <br />