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~. i <br />Contact: ~-~ y,,, ~ j~ jr' 1) Ensure proper container packaging. Table 1. -Matrix Type <br />Address: rjC~~ y ~ ~ /Z ~ 2) Ship samples promptly following collection. 1 =Surface Water, 2 =Ground Water <br />~~'g~~i1 C~ ~" L ~ I ~~ 3) Designate Sample Reject Disposition. 3 = Soil/Sediment, 4 = Rinsate, 5 =Oil <br />Phone Number. 4~7 p ._ 3 ~~.~ y S ~ ~ ~ ~ !~' pp# 6 =Waste, 7 =Other (Specify) <br />FAX Number. S/~p •- ~ ~~=t;/~,~ ° Project Name: JiV ~' ~N(o S piers Signature: ~_ <br />Page of <br />FOR GAL USE ONLY <br />GAL JOB # <br />O 7/Z 2~ <br />Lab Name: Green Analytical Laboratories, Inc. (970) 247-4220 FAX (970) 247-4227 Analyses Required <br />Address: 75 Suttle Street, Durango, CO 81303 <br /> <br /> Colle ction Miscellaneous PYe servative (s) <br /> z <br /> .. <br />• ~ <br />~ <br /> <br />Sample ID <br />Date <br />Time . <br />~ <br />~ <br />~ ~ ~ <br />C <br />'_ c. <br />~ v <br />~ T <br />~ ~ <br />~ <br />Comments <br /> U <br /> H <br />~ o <br />° ~ <br />~ a <br />p, M <br />O <br />.a ~ <br />~ ~ <br />O v ~ <br /> U ~ ti Z ve ~ ~ s x Z O ~ <br /> <br />1. WIZ 7~~' l~ z'[. <br />/Z (.. b "~ <br />~ <br />Z ee <br />'~ <br />N ~~~~ <br />K P~U <br /> <br />3 ~2 tea cis ~' ! 6 0 "7 Z <br /> <br />5. ~ <br />b <br />6. 4 ~ <br />. <br />7. y <br />,n R <br />s. <br />9. <br />10. <br />Relinquished b Date ~ ~ U <br />// Time: Received by: ~ Die: Time: <br /> <br />Relinquished by: <br />Da <br />te: <br />Time: <br />Received by: ~ <br />D/aLte: O <br />Time: <br />fi sample Kelect: [ ] Keturn [ ]Dispose [ ]Store (30 Days) <br />~lo~ <br />Ito <br />1111 <br />It~~- <br />