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ANALYr1,ICA <br />ENVIRONMENTAL <br />LABORATORIES <br />CHAIN OF CUSTODY RECORD <br />325 Interlocken Parkway, Suite 200 <br />Rroomlield, Colorado 80021 <br />(303) 469-8868 or 1-800-873-8707 <br />FAX: (303)469-5254 <br />CLIENT NAM ~ '~ (V (,OJT {~~ <br />L)'1-yG U Uk F r- CLIENT COt~TAf~T~ <br />r'~~~ N e~~ /~. r <br />' <br />1 ANALVTICA <br />USE ONLY <br />N~~ g o o s 6 s <br />CLIENT ADDRESS ~-I PRO <br />N <br />JECT ID/DESCRI/P~TIO <br />~~lr.~~F C ~ X03°~ CSN <br />TELEPHONE <br />LGN OS <br />FAX P.O.NO. TESTS REQUESTED <br /> <br />' LOC <br />Sample Ma <br />circle one) <br />WATER SOIL OIL SLUDGE <br /> <br />NO <br />ac <br /> <br />OTHER (specily) <br /> <br />r m <br />tri <br />NOTE <br />Ch <br />i <br />f C <br />d <br />t . <br />of <br />BOTTLES <br />~ <br /> <br />PM <br />x) <br />( <br />: use one <br />n o <br />us <br />o <br />y pe <br />a <br />a <br />DATE TIME CLIENT ID DUE <br />3-Iz~e .2 ~7X: e fc~ s 50 W / ~~ ~ <br />.- <br />-/i-~ /: uorM E 3= l~rP l - - <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />..~.~~.~~~. ~„ ~~Eauc nr nc LIVEPV <br />~0~~ <br />~IN U~BV DATE/TIME <br />3-/y-yd RECEI ED DATE/TIME <br />~,/k-~ ~ RELINOUISriED BY DATE/TIME RECEIVED BV DATE/TIME <br />003-0294 <br />