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CHAIN-OF-CUSTODY FORM <br />Enviro-Chem Analytical, Inc. <br />685 West Gunnison Avenue <br />CLIENT I"t~_r<'..::n~,~ - ~%c; . y S=~y~~~~~ ~ Suite 108 <br />ADDRESS r~ ~ :'_z<:,~_, r, ~ J Grand Junction, CO 81505-7249 <br />.~ fµ ~'s~3 r".;;, a'>`r'3.3 (970) 242-6154 phone <br />PHONE `~> `~` ~ - K'%~i FAX ~ ''~~ -~ ~ 9 f (970) 245-9270 fax <br />PROJECT ~~; , tip ,~d ; f f <br />SAMPLER'S SIGNATURE ~Y il ;~ / <br />- ,~ - n <br />{ T~ ~'•,~~ rl <br /> <br /> <br /> Sample Sample Analysis ~ ~o. of <br /> <br /> <br />Sample I.D. <br /> <br />Date/T'ime <br /> <br />Location ~w f..~ ~ ~ ~ ~ l <br />t., <br />~ ,~~ ~ ~f ~~~~ .~; ~j ,,' C tainers <br /> ~ <br /> tc-7..a-e:~ ~ t <br />~ ~, <br />~ <br />` <br /> ic-~;~~r>E, ~ <br />~ t <br /> f ~ ~ . <br /> ic~_ 2S~~JG <br />~t,.'--C.i' S: .3bI7M S.lr~~k. ~ ~ ~ V i <br /> <br /> ~ t <br />~~ i. f7 .~ -. ~~-b q h~. ?b4, ~k ' I ~ <br /> ~ ~ <br />~y <br /> <br /> S~.if QZcLa , ~ ~ ~ [ <br /> <br /> <br />Relinquished By: ~--~-':~'. ~- --- Accepted By: ..,?„ ' }i-.i„ '~9.v-; a<~ %~- <br />Date/rime // - i- ~ /'~ ~.'4'.-~' ~F+-, DatelTime %/ / i /: a: ~ 1,~i ~^ %i r <br />Relinquished By: Accepted By: <br />Date/Time Date/Time <br />FOR LAB USE.ONLY <br />Seals Intact: YES NO <br />Received in Good Condition : YES NO <br />Special Irrstrucdons: <br />Preserved Properly: <br />How <br />Adequate Sample Received: <br />Holding Time Met: ~-YES' <br />Delivered By:. ' HAND• <br />UPS <br />NO <br />'YES 'NO <br />NO <br />USPS FedEx <br />Other <br />