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vl <br />of <br />03 <br />o~ <br />a5 <br />Analytical <br />Labaratorlaa Mo <br />Client: ~~ (y'y/Vf~ <br />contact: ~nY W I t3~ <br />Address: (sue yLL <br />Phone Number: <br />FAX Number: <br />CHAIN OF CUSTODY RECORD <br />NOTES: <br />i) Ensure proper container packaging. <br />2) Ship samples promptly following collection. <br />3) Designate Sample RejeM Disposition. <br />PO#t <br />Project Name: ~ [C ]Zt Q/e r'" <br />Table 1. -Matrix Type <br />1 =Surface Water, 2 =Ground Water <br />3 = SoiVSediment, 4 = Rinsate, 5 =Oil <br />6 =Waste, 7 =Other <br />Page_ of _ <br />PoR 6AL Uaa ONLY <br />GAL JOB # <br />Yo3-Of ~ <br />Lab Name: Green Analytical Laboratories, Inc. (970) 247-4220 FAX (970) 247-4227 A alys es R equir ed <br />Address: 75 Softie Street, Durango, CO 8]303 <br /> Colle ction Miscell aneous Pre serv ative (s) <br /> <br /> <br /> <br />ample ID <br /> <br /> <br />ate <br /> <br /> <br />ime <br /> <br />C <br />~ <br /> <br />c~ <br /> <br />d <br /> <br /> <br />~w <br /> <br />g~ <br />'F <br />0 <br />z ~ <br />i~ <br />h <br />~ <br /> <br />~ T <br /> <br />C <br />$ <br /> <br />a <br /> <br /> <br />~ <br /> <br /> <br />x <br /> <br /> <br />~ <br /> <br /> <br />z <br /> <br />~ <br /> <br />~ <br /> <br /> <br />omments <br />1. QtEA Gr/ on! 3"~- d Ce <br /> <br />3. q ~? <br />a. ~ (~ * 11 t/ / <br />s. N 3aU w <br />6. <br />7, <br />8. <br />9. <br />t0. <br />Relinquished by: _ ~~~ Ti Received by: Date: Time: <br />Relinq ' by: Date: Time: Received by: Date: Time: <br />* Sample Reject: [ ]Return [ J Dispose [ J Store (30 Days) <br />