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IG <br />Inlnr- Mountain <br />Laboratories, Inc. <br />CHAIN OF CUSTODY RECORD <br />CII nUProJect Na a <br />JOCy~ ~ project Location <br />~~~,~jfl~~ ~,.~~~~ <br />Ul~.~ <br />ANALYSES /PARAMETERS <br />Sample~(Signature) <br /> <br /> <br />Sample No./ <br />Identification Date Time Chain of Custody Tape No. <br /> <br /> <br /> <br />ab Number Matrix <br />~ <br />c ~~ <br />o o <br />zo ~ ~ <br />Remarks <br />A:e,~ ~~ ~ 9 iv°~~' 331E 1~47~~~ 1 <br /> fC.~ I <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> Time <br />~~ Received by: (Sign lure) <br />~ Date Time <br /> Time / Received by: (Signature) Date Time <br />I <br /> Time Received 1 or o : (Signet re) Date <br />n-Frot Time <br />~~'. ~~' <br /> oratories, Inc. <br />Q <br />2506 West Main Street <br />12718 Farmington, NM 87401 <br />32-8945 Telephone (505) 326-4737 <br />~ <br />71183 State Hwy. 30 <br />College Station, TX 77845 <br />Telephone (979) 776-8945 <br /> <br />~ ~ Q <br />