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The foaCrert cGrou~ Purchase Order Number <br />Chain of Custody Record <br />1341 Cannon Street • Louisville, Colorado 80027 (enclose with each shipping container) <br />303-661-9324 • FAX 303-661-9325 Project Numbertlabuseor,~yi <br />Client: Contact: ~ Address:~oX~9~ <br />Program/Site: ~ Phone: d ' • ~.~. ~..8_ ~ ~' ~~ <br />Collected b Acute Chronic 7h toe field test esulis ed <br />a g a <br />o .?' ti <br />c ~' ~ r 1~ <br />Sam le <br />F Sample,ldentification G Dat P~ T mp Type o ~T ~ 0 4'F ~ ~ ~ na Total t TotalQ <br />1 , <br />, <br />2 , <br />3 ~ <br />4 :-~ „~,~ <br />j.~ <br />5 <br />6 <br />7 <br />8 <br />9 <br />10 <br />Comments and special testing instructions: ,.~~,~'... ~nli ' .~;ti~ ~ . ~-~ ~r <br />.. ~ u. ._ ~' F o-. h, ~.° P .'S x~ r_v.'. <br />Relinquished byi <br />Relinquished by: <br />Next recipient: _ <br />Representing: <br />Representing: <br />Relinquished by: <br />WHITE COPY: Accompanies samples <br />To Whom: Date/Time:7~g~0,3 <br />To Whom• ~ Date/Time: <br />~ ~. <br />Recd tfy~ C, Date/Time: ~' ~ ~~~ <br />CANARY COPY: Client <br />