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LZ ~ ~G3 <br />CHAIN OF CUSTODY RECORD Laboratory Sample Numbers (ACZ Use Only): COC # 16 6 9 4 <br /> <br />ACZ Name to Appear on Report and Invoice: cc: (Report) - (Invoice) to: (circlg one or both) <br />5:~ ~ ~.~\ • W t~t~-- <br />AI.:.•.~ l n k <br />Laboratories, Inc. <br />2 <br />3 D <br />h _ <br />[\'lti"H"'w~~.~~ tkv ~ t ~ r..~ - <br />N^^"-''a"~`}'- <br />own <br />77 <br />ill Drive <br />Steamboat Springs, CO 80487 <br />(970) 879-6590 • (800) 334-5493 • <br />b S ~rrli rn.r.c .~u.~c%•~ ~w ~L <br />Attn: ~ t~~kSc-o « Tel: (y/5 3_ I ,~~Attn: Tel: gog <br />Project or P.O. # A NALY SES REQU ESTE D <br />Bc~L~ /Yi.,,,•,~ # 2/06 <br /> <br /> <br />Gr~-~ , C.,~ $ t ~ 30 ~ <br />W <br />z <br />~ <br /> <br /> <br />a n-~~ REMARKS <br />ylY <br /> <br />g 1999 <br />~ <br />Shipped Via: FED X_ Hand_Other ~ ~YI N~~ <br />• <br />SAMPLE IDENTIFICATION DATE TIME Sample <br />Matrix a ~ <br />io - ~ ~G W i~/~ /~:oo Su) ~ ~ <br />10-- 8 % c%i ~f (0 2 /5,'YS 5W s <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> o nl Z <br />• Matrix Opticns: SW (Surface water) • GW (Grountl water) • WW (Wastewater) • DW (Drinking water) • SL (Sludge) • SOIL • OIL • Other (Specrty) COMMENTS C (p <br />a' <br />co <br /> <br />SAMPLE DISPOSAL OPTIONS -Please complete section A, or choose one option hom sections B AND C. <br />Proper charges w/ll be assessed. te <br />„ <br />n <br />y ~ p ~ <br />~~ ~ <br />4 <br />(A) Long-term storage <br />Hold until (date) <br />for future analysis. ~ It Sample is Non-Hazardous <br />t ocal Disposal <br />2) RCRA -Permitted Facility <br />3) Return to Client (C) I/Sample is Hazardous <br />t) RCRA-Permitted Facility <br />2) Return to Client ~ <br />o <br />RELINQUISHED BY: (SIGNATUR E) DATE TIME RECEIV BY: SIGNATURE) DATE TIME PAGE a <br /> JO •-Z - /L'-2 ' y~ <br />U ~ G ~ ~4cv <br /> OF <br /> <br />White -Return w/ sample Yellow -Return w! sample rink - rleturn wr sampie L;oic - tceep ror your recoros <br />