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<br />ACCU-Labs Research, InC. CIIAIN OF CUSTODY AND SAMPLE TRANSMITTAL FORM <br />4663 Table Mountain Drive Golden, CO 80403-1650 ALR Job a: <br />(30~~277-9514 FAX 1303) 277-9512 <br />razor n~. r <br />' <br />' PLF~SE FILL OUT COMPLETELY. Bottle Size & Preservation Pa a of <br />f,,t BE SURE SAMPLE ID+r MATCHES SMAPLE LABEL Total <br />1 <br /> <br />ALR <br /> <br />Use <br /> <br /> <br />ale OI <br /> <br /> <br />ime Of <br /> <br /> <br />ample Number <br />of <br />Bottles <br />Per . <br />~v \ b ,~C <br /> <br />y <br />A <br />l <br />d <br />Only Collection Collection Type Sample Identilicalion Sample , , <br />na <br />yses Requeste <br />~ ~ b ~ (Attach Additional Pages II Necessary) <br /> ~ s q ~ ~ 94~o~i~_ boa ~ C ~,~ v - (~i~rv <br /> /! r 4 Ir ~ '/ <br />F <br />U~GC.Q <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Clien: (Jame E2 W / /~ APPLICABLE REGULATION: 1) 'nquished B : Da and Tlme R r -~ <br />ntact <br />(tor report) SDWA NPDES <br />Clieni Co t ~ ~ ~~ Q~ 7 <br />yy <br />// / ''''~~ <br />Phone (/~) lO7o7 ' ~3b~ FAX (~r 7 1 ~ 7a -3 3(03 CWA RCRA Re i By: Da and Time Receive y: <br />Sampler (Print Name): Other N/A 7~0 vr7 <br />SALCY ~/~/ j' `S /I/V/(.J W C~/L}-~ Notify 1_ab of any special turnaround 3) R li ulslied By: Uale and Tlme ILeceived for ALR By <br />S 41er S' r lure) <br />/~ Ibnc or QA Requirements <br />~1- ~~ <br />-~ ' ~ <br />roj¢cl or PWSID <br />urchase Order b: <br />ALR Contact: <br />Remarks <br />voice To: _ _ _ <br />~ r wn nvccnvre TrrC nrCrrr Tn nRT1lnA1_I_ILn rr.`n n '~~-• -+ <br />