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® HAZEN RESEARCH, INC, <br />WAZEN 4601 INDIANA STREET <br />- GOLDEN, CO 80403 <br />Phone - (303) 279 4501 <br />Fax - (303) 278 1528 <br />CHAIN OF CUSTODY RECORD <br />Customer Information Billing Information (If different) <br />Client Name: DGMC Billing Name: <br />contact: James Bender Billing Contact: <br />Address: 5529 US Highway 64 Billing Address: <br />Farmington, NM 87401 <br /> <br />Phone: 505 632 1276 Faz: ~~ - . ~ -t_~G ~ `d PO #: Project #: <br />Sam ler's Names Print i <br />p O ( ) ~~~~ 1 j~j1Jl~~~\ {Signature) / ~~"~'-`-'~ <br /> <br /> <br /> <br /> <br />e Identification <br />Sam <br />Sample <br />Date <br /> <br />Time <br /> <br /> <br /> <br />j <br />~ <br />a <br />E <br />~ .-, <br />a <br />~ <br /> <br />~ <br /> <br />~ <br />~ <br />z° <br />a <br />~ <br /> <br />~ m <br /> <br />~ <br />8 <br />o` <br /> <br />DEC 0 6 2002 <br /> <br />Analyses Required]iuision of Minerals and G <br />p <br />~I oCI / ~ ~ /~~„~,,,r.p,,y~e~j~i;i,<<, ~ ~~ 1 P C Conductivity, pH, Sulfate <br />~t'~/C ~ ri~,a~>:"a~or;r. ~ ru!i r'l , C 1 P B Cyanide <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />(1) DW=Onnking Water WW=Wastewater SW=Surtace Water SO=Soil GW=Grountl Water SL=Sludge HZ=Hazardous O=Other <br />(2) P=Plastic G=Glass O=Other ~- <br />(3)N=Nitric Acid U=Unpreserved C=Cooled S=Sulfuric Acid B=Sodium Hydroxide T=Sodium Thiosulfate Z=Zinc Acetate O=Other <br />Relinquished by <br />~? Received by Date/ Time <br />/ <br />Relinquished Received by Date/ Time <br />Relinquished by Received by Date/ Time <br />Shipped by .Date/ Time cerved for LabWy ` Date/ Time <br />Method of. ipment Requested Tum round Time <br />Standard ~ Rush (Must be approved, additional charges apply) <br />Lab use only <br />i <br />COC Nrrrare Wmfe xls <br />