Laserfiche WebLink
® HAZEN RESEARCH,Ii'~. <br />~w~N 4601 Indiana SL • Golden, CO 80403 <br />® Tel: (303) 279-4501 • Telex 45-StiO <br />i <br />CHAIN OF CUSTODY RECORD <br />~I Ho•11 Prot/ec~t~N~a/mo// y J ¢ 1 <br />Samples (Slgiv7ur4) ~.~^7 ~ ~ <br /> <br />a. <br />N <br />o. <br />Dat <br />o ~r• <br />Tfm~i <br />m <br />Gr <br />ab <br />Stallon Loeallon No. of <br />Con <br />l <br />aloes <br />Remarks <br />1 <br />( g <br />l \ / <br />/ <br /> ~!/~ ~^(/ f' I <br /> <br />~ '/~ ~./fr ~•G 1 u ~ <br /> <br /> <br />~ ~/~„fir r`'S-6 X <br />G~ ~2r~i / ~lU <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Rellnqulshed b ; (Signature) DrfWTlmo Rseahsd by: (Slgnafure) Rsllnqulshed by: (Slgnafure) DaWT1me Rocelred by: (Slgnafure) <br />Rollnqulshsd by: (Slgnafure) DatelTlmo Rocohed by: (Signature) Rsllnqulahed by: (Signature) Deto/Tlmo Racehad by: (Slgnafure) <br />Relinquished by: (Slgnafure) DatsrTitno Recshed for laboratory by: <br />(Slgnafure) Romarks: <br />Dbtrlbutbn: Whh~ Copy • Shlp With bampk; Canary Capy -laboratory Copy: Pink Capy - Orlpln~tor'a Copy <br />•r. ~ <br />• -o <br />^ N <br />.'m <br />m <br />fb <br />O <br />m <br />a <br />I~ <br />U <br />• <br />r <br />