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CHAIN-0F-CUSTODY FORM <br />CLIENT A ;,,,~, ~ '~ <br />ADDRES <br />PHONE FAX <br />PROJECT <br />SAMPLER'S SIGNATURE <br />Enviro-Chem Analytical, Inc, <br />685 West Gunnison Avernie <br />Suite 108 <br />Grand Junction, CO 81505-7249 <br />(970) 242-6154 phone <br />(970) 245-9270 fas <br /> <br /> Sample Sample No. of <br />Sample I.D. Date/Time Location Containers <br />r~~,,,,,N,«~~, 9~,0/~ ~ <br /> ~ <br /> <br />. Q'~ } ~ O <br />'~ <br />FAi1't5S-a <br />/o.~cr~~r / <br />u~~S.G !"< q'~'3' 0 7 <br />3 .: ,, ~ <br />~n. W~-.ts~? <br /> <br /> <br />qn, ~ T a ~~ / <br /> <br />>~', w r--tf ~~ <br /> <br />Relinquished By: <br />Date~Lime <br />Relinquished By: <br />Date/Time <br />~Pt~ ~v~ ~ ~ ,. <br />Date/Time ~~-/9 'o'% S; c o {Ij <br />Accepted By: <br />Date/Time <br />FOR LAB US1; QIVLY <br />Scab ]ntact: / YF.$.~ NO <br />Received iq Ganditbn NO <br />~~ Insuoctio~ <br />Praavad Properly: ; YFjS NO <br />How <br />Adegwte Sample ~ NO <br />HoldmgTmu Met:- NO <br />Delivered By: HAND LISPS FedE.~ <br />UPS Other ~.: <br />