HYDRO29159

• Permit No: C1992080
• IBM Index Class Name: Hydrology
• Doc Date: 1/6/2005
• Doc Name: 2004 SWMP Annual Report
• From: Savage & Savage
• To: WQCD
• Permit Index Doc Type: NPDES
• Media Type: D
• Archive: No

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Analytical
Leboratorlee, Inc
Client: OAKfu~~ a~ L-~tC
Contact: M t~ti MIL S.AJ A-C~
Address: ¢G ] p I•l4~IS ~ nR .
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Phone Number: `l$p 6a-4 POGO
FAX Number: ~{7 (~.sy- ~jQQg
CHAIN OF CUSTODY RECORD
NOTES:
1) Ensure proper container packaging.
2) Ship samples promptly following collection.
3) Designate Sample Reject Disposition.
PO#
Table 1. - Matrix Type
1 =Surface Water, 2 =Ground Water
3 = Soil/Sediment, 4 = Rinsate, 5 =Oil
6 =Waste, 7 =Other
Project Name: Qg~ •1~ t70L
Page_ of_
FOR GAL USE ONLY
GALJOB#
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Lab Name: Green Analytical Laboratories, Inc. [phone] FAX [phone] An alys es R equi red
Address: 75 Suttie Street, Durango, CO 81303
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'~ Sample Reject: [ ]Return [ ]Dispose [ ]Store (30 Days)