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^1 <br />' "~ Colorado Analytical <br />Laboratories, Inc. <br />•_ _ __ -~_ <br />CHAIN OF CUSTODY RECORD <br />COMPANY NAME: <br /> <br />,,~ ~ <br />I~! ~ SL~-'"~`~~ CONTACT PERSON: <br /> <br />s'D <br />D~""`''`' <br />Colorado Analytical <br />•La6oratories, Inc. <br />P.O.Drawer507 LABORATORY . <br />USE ONLY <br /> <br />~~ 023652 <br />nnr;PE~e: !!)) <br />~ r ~~~ G(Itj'U PRQ.IFrT ID ! DFSC -PTION: 24^v .°wiit h viain street <br />r= <br />CITY/ST21P: j~ ~D •0~,~ O // ~~~° j <br />L~vc~ ~ Brighton, Colorado 80601 <br />303-659-2313 <br />~~ `~ <br />~ <br />` <br />TELEPHONE: ~ ~ ~ Z~3 ~ _/~~ ~, SAMPLED BY: ~ FAX: 303-659-2315 r <br />6 <br />LAB # <br /> <br />FAX; ~ ~ ` $.)}j ' o~ ~J~ P.O. NO.: <br />. TESTS REQUESTE D <br />LGN <br />Sample Matrix (Circle One): <br />DRINKING WASTE GROUND SURFACE SOIL SLUDG <br />WATER WATER WATER WATER <br /> <br /> <br />OTHER (Specify): ~ <br />z <br />~ <br />z <br />o <br />~ .;, <br />~ <br />~ <br />'o ~ <br />Y ~ <br />=W o <br />' Q ~ g _ <br />~ - <br />; ° <br />~ ¢ `. <br />3 <br />Q zZ <br />° o z <br />\ <br />LOC <br /> <br /> <br />Qc <br /> <br />DATE <br />TIME <br />CLIENT SAMPLE ID: <br />~ <br />~ of ~ W= <br />~ ~ ~ - <br />DISP <br />t a~f S - ~S~' C l~ w -- ~ I x . ?C <br />u <br />1 2 Y G2Vh W _d <br />1 <br />, <br /> REPORT RESULTS <br /> TQ CDH: Y oR .N , <br />.(DRINKING WATER QNLYJ <br /> ,PUBLIC WATER SUPPLY INFOR: <br /> PWSID: <br /> $YS NAME <br /> - <br />.. <br /> <br />_ ADDRESS <br />, <br /> 'CITY/STATE _ .. <br />... .. <br /> ZIP. <br /> <br /> CQUNTYt • <br /> <br />CQMMENTS: DELIVERED BY: <br />RELINQUISHED Y <br /> <br />~~~~ DATE/TIME <br /> <br />/ u ~~ ~3v REC D B <br /> <br />: DAT I - <br />I l~zl~flSr <br />~ RELINOUISHED BY <br /> <br />• DATE/TIME RECEIVED BY DATE/TIME <br />240 S. Main St. ~ Brighton, CO 80601 • X303} X59-2313 Mailing Address: l'.(.~. urawer ~r}~ tsngnton, ~,v rsuev I <br />