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The Ie~Creft Group <br />An Enrlronmental servlceo Company <br />1341 Cannon Street • Louisville, Colorado 80027 <br />303-661-9324 • FAX 303-661-9325 <br />Client: -r! \a--s!.~"0.~ Co a,Q ~',o <br />Program/Site: ~t `~ s°~- ~ ~ <br />Collected by: M1~_~IZ£XOp(~ <br />Sample <br />Sample Identification Date Type <br />irm~~am ea~o;~;,,~ ~a,~,ma.., ~ Sampled Time <br />Purchase Order <br />Project Numberllab use e~lyl <br />~~~ ~ 2~~ <br />fi1e-(~elds may be used <br />h-field test results <br />Total Total <br />Units Volume <br />Chain of Custody Record <br />(enclose with each shipping container) <br />•Yd4• <br />Acute <br />3 ~ <br />0 <br />o r m o <br />v c ~o ar <br />U ~ w U <br />4r Q <br />Address: <br />Chronic <br />3 y <br />0 <br />mm ~¢ r ~ <br />4 c O ~[ <br /> o~ 7 ~-~cu~~ . 03 : ~ ~ a <br />z <br />3 <br />4 <br />5 <br />6 <br />7 <br /> <br />9 r ~r,, „. <br />10 <br />- /YQ'ti- ~Q~a-~' dvrlrsj7.y~. <br />Relinquished by: <br />Relinquished by: <br />Next recipient: _ <br />~{e' <br />Representing: (•,~~ To Whom: ~~S Date/Time:7-(5.O (,~C(N <br />Representing: To Whom: Date/Time: <br />Relinquished by: Recd by: ate/Time: 7'l(n'~s ~~`~~ <br />WHITE COPY: Accompanies samples CANARY CO Y: Clien <br />