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~1 <br />• "'~ Colorado Anal ti~al <br />~Laborataries, Ina. <br />CHAIN OF CUSTODY RECORD <br />COMPANY NAME: CONTACT PERSON: LABORATORY <br />/ Colorado Analytical USE ONLY <br />~ ~~ <br />i~ ` <br />f <br />~ ~Laboratorles, In[. <br />D <br />P <br />7 <br />O <br />tFDDRESS,~~ <br />, <br />~ri~~ PROJECT ID/DESCRIPT N: . <br />rawer50 <br />. ~~ 023649 <br />~~~ <br />~ <br />JY~ 240 South Main Street <br /> <br />CITY/STRIP: <br />~~ ~~ 3 ~ <br />~~ S Bri hton, Colorado 80601 <br /> L~ 2313 <br />303 <br />659 <br /> <br />TELEPHONE: <br />:3 <br />~ <br />~ ~ ~ <br />.3 <br />' .~ ~ <br />SAMPLED ~-- - <br />- f ~~ /s <br />~/ <br />C <br />~ <br />. <br />- l , , FAX: 303-659-2315 LAB # <br />~ <br />FAX: ~~~ ~ ~~ ~~ ~$ S P.O. NO.: TESTS REQUESTED <br />Sample Matrix {Circle One ~ ~ ; , :;; LGN <br />DRINKING WASTE GRO ND SURFACE SOIL SLUDG w: Z Z , <br />• <br /> <br />WATER WATER WATER WATER z <br />~,` ~ <br />o ~ ~ ° <br />~ Q ~ LOC <br /> <br />OTHER (Specify): z <br />~ U Cn <br />m _ ° J W~ <br />~ ~ ? a <br />~ <br />QC <br /> ~ Qv ~ ~ O L ' <br />DATE TIME CLIENT SAMPLE ID: O. ~ ~ ~ ~ ~ o ~ DISP <br /> <br /> <br />~ 7~ ~ ~ ~ 1.? ° ~ ~ ~ ?~ X REPORT RESULTS <br />ID ~yi G Z w"'-~ ~' ~ . X K X Tq CDH: Y oa N` <br />(DRINKING WATER ONLY) <br /> ~ Wk A - ~ ~ ~ ~ ~ ~ <br /> ~ ` PU6LIC WATER SUPPLY tNF;OR <br /> . <br /> PW <br /> SID; <br /> <br /> SYS-NAME: <br /> ADDRESS:`' <br /> CITY/STATE:." <br /> ZIP: <br /> <br /> <br /> <br />COMMENTS: DELIVERED BY: <br />RELINQUISHED BY DATE~TIME RE VED Y Dr;F€~I ~ RELINQUISHED BY DATErf'IME RECEIVED BY DATE/TIME <br /> <br />240 S. ~ St. Brighton, CO 80601 ~ (30~ 659-2313 ailing Address: P.O. Drawer 507 Brighton, CO 806 <br />