Laserfiche WebLink
CHAIN-OF-CUSTODY FORM <br />CLIENT ~12T' ]~ Al ~ AY' , <br />ADDRESS (~~?~ ~'~ RoAj~ <br />Lb~/~-A ~ Co <br />PHONE r:`3~$ • ~/00~1 FAX 5~8~ ~'Z~ I <br />PROJECT' ~ kC-= ~ IVL f ~ <br />SAMPLER' S A ~ <br />~~~! <br />T- <br />Enviro-Chem Analytical, Inc. <br />685 West Gunnison Avenue <br />Suite 108 <br />Grand Junction, CO 81505-7249 <br />(970) 242-6154 phone <br />(970) 245-9270 fax <br />C, <br /> <br /> <br />Sample I.D. Sample <br />Date/Time Sample <br />Location Analysi ~ No. of <br />~ ~ Containers <br />f`~c~lC~ 1~ la~rh ~t~-2 <br /> <br /> <br /> <br /> <br /> <br />Relinquished By: G~l/C/ <br />Date/Time S-/5~- 03 ~: 30 ~~ <br />Relinquished By: <br />Dateffime <br />FOR LAB USE ONLY <br />Seal Intact: YES NO <br />Received in Good Condibo~ jV0 <br />Spedal Imtnuxions: <br />Accepted By: ~C~ <br />Date/Time ~ /S ~~ ~=~gfy/1~ <br />Accepted By: <br />Date/Time <br />Ptesetved Properly: ~ NO <br />How <br />Adequate Sample Received: Y~£4j NO <br />Holding~meMet• ~~f0 <br />Delivered By: ~~ USPS FedEx <br />UPS Other <br />