Laserfiche WebLink
Analytical <br />Laboratories, me <br />Client: GlJ'~(% ~ <br />Contact: <br />Address: <br />CHAIN OF CUSTODY RECORD <br />NOTES: <br />1) Ensure proper container packaging. <br />2) Ship samples promptly following collection. <br />3) Designate Sample Reject Disposition. <br />Phone Number: ~t-~7-Q/3Z PO# <br />FAX Number: ~~-~ ~, Project Name: ~~~~~ f,~,l ~ita/.., <br />nn ~ <br />Page ~ of <br />Table 1. -Matrix Type FOR GAL 115E O<;LY <br />1 =Surface Water, 2 =Ground Water GAL JOB # <br />3 = SoillSediment, 4 = Rinsate, 5 =Oil y 63/0 <br />6 =Waste, 7 =Other (Specify) <br />Samplers Signature: <br />Lab Name: Green Analytical Laboratories, Inc. (970) 247-4220 FAX (970) 247-4227 Analyses Required <br />Address: 75 Suttle Street, Durango, CO 81303 <br /> Colle ction Miscell aneous Pre serv ative (s) <br /> T <br /> _ r a <br /> C <br />.w <br />U C' <br />y N <br />U <br /> <br />Sample ID <br />Date <br />Time <br />p <br />~ <br />~ <br />v y <br />„ <br />~ <br />~- <br />v <br />Comments <br /> a <br />F w <br /> v F U ~ ~ <br />o ,d, <br />O h C <br /> ?: m o ° E c .a ~ r <br /> U ~ w Z, ~ 5 x x x z O <br /> ~2i I Z ~ /~ <br />z.5 G~ z3 tl Z Z <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />]0. <br />Relinquished D ~ <br />~ Ti ` <br />J Received by: Date: Time: <br />Relinquish y Da Time: Received by: ~ D [e_ Ti <br />v( <br />ati <br />' V <br />* Sampl cn [ ]Return [ ] Dispo e [ ]Store (30 Days) • • <br />