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6 - <br />Y <br />CHAIN-OF-CUST®DY FORM <br />CLIENT"~p~~~~ ~ C <br />ADDRESS`~~ ~ ~ x 5~~ <br />~~ ~~ <br />PHONE ~ - ~~3 PAX Z -- <br />PROJECT I ~ <br />~~~MP S SIGNATL7RE ~~ <br />Enviro-Chem Analytical, Inc. <br />685 Nest Gunnison Avenue <br />Suite 108 <br />Grand Junction, CO 81505-7249 <br />(970) 242-6154 phone <br />(970) 245-9270 fax <br /> <br /> <br />Sample I.D. Sample <br />Date/Time Sample <br />Location Analysis l~To. of <br />~ Containers <br />©~ ~ ~~ . a a,o7 o ~ ~ <br /> 30 a~ <br />©~ ~ ~~ ~ as • 0.7 <br />D'. 30~ ~ t7 <br />~ ~ ~ <br />~ <br />~ <br />~ 5 <br /> ~~ ~ t~( 8 <br />fCD 6 C <br /> <br /> <br /> <br />Relinquish <br />Date/Time <br />Relinquish <br />Date/Time <br />FOR LAB USE O~iI~Y <br />Seals Intact: ~;~~'~~ NO <br />Received in Good Condition <br />Special Instructions: <br />~. <br />Accepted B ,-, _ <br />Date/Time v 2 ~ - v <br />Accepted By <br />Date/Time,~~_Z3 ~ ,~/%~o ni /~' <br />Preserved Properly: Fes'' NO <br />How <br />NO Adequate SampleRece' ed: NO <br />Holding Tune Met: NO <br />Delivered By: UsPS FedEx <br />UPS Other <br />