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CHAIN OF CUSTODY RECORD Laboratory Sample Numbers (ACZ Use Only): COC # 19 8 5 3 <br /> <br />~~ L <br />b Name t'~Appear R art anc~ lnvpice: cc: sport - (Invoice) to: (circle on c both) <br />.~i <br />e <br />oratorles, Inc. <br />2773 D <br />nhill D , ~ , <br />ow <br />rive <br />Steamboat Sprin <br />CO 80487 <br />s 2d7~ <br />g <br />, <br />(970) 879-6590 • (800) 334-5493 Attn: Tel- Attn: Tel:~q~ Qp <br /> <br />Pro'ect or P.O # A NALY SES REQU ESTE D <br />I <br />~'~ ~~/3~ W REMARKS <br />Shipped Ya: FED X_ UPS_Hand_Other <br />SAMPLE IDENTIFICATION DATE TIME Sample <br />Matrix <br />~ s <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />• Matrix Optioru: SW (Surface wafer) • GW (Ground we(ar) • ww (Wastewater) • OW (Drinking water) • SL (Sludge) • SOIL • OIL • Other (SpecAy) COMMENTS <br />SAMPLE DISPOSAL OPTIONS -Please complete aect/on A, or choose one option hom sect/ons B AND C. <br />Proper charges will be assessed. <br />(A) Long-term storage <br />Hold until (date) <br />for future analysis. (B) h Sample Is Non-Hazardous <br />t) Local Disposal <br />2) RCRA -Permitted Facility <br />3) Retum to Client (C)1I Sample /s Hazardous <br />t)RCRA-Permitted Facility <br />2) Return to Client <br />RELINQUISHED BY: (SIGNATUR E} DATE TIME RECEI D BY: NATURE) DATE TIME PAGE a <br /> ,. ~ ~ / !~ <br /> OF <br /> <br /> <br />White ~ Return w/ sample Yellow -Return w/ sample Pink -Return w/ sample Gold -Keep for your recortl5 <br />