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' '~ Colorado Anal tiCal <br />~Laboratarles, In~.~ <br />CHAIN OF CUSTODY RECORD <br />• <br />COMPANY NAME: <br />c \ ~ ~ SG~~n ~ <br />V ` l~ CONTACT PERSON: <br />~ <br />Colorado Analyt(~al <br />•Laboratorles, In[. <br />Drawer 507 <br />P <br />O LABORATORY <br />USE ON <br />*1 <br />N .. 0 2 7 3 3 f~ <br />ADDRESS: ~`~~ ~~AC ~ <br />`"'ff ~` PROJECT ID / ESCRIP N• <br />~ <br />~ . <br />. <br />240 South Main Street <br /> <br />CITY/ST/ZIP: r~,~ <br />~~~f <br />1 <br />`~'"'" ~~ Brighton, Co{orado 80601 <br />303-659-2313 <br />Q <br />"} <br /> <br />TELEPHONE:343 ,~~~^! /i~r_ <br />11dd <br />` <br />SAMPLED B ~,~,~ ` ~`-{~~' "' <br />FAX: 303-659-2315 ® <br />/ <br />/ <br />LAg # ~ C/ ~` v <br /> <br />FAX: © '' ~ <br />o ~V P.O. NO.: TESTS REQUESTE D <br /> <br />Sample Matrix (Circle One): <br />DRINKING WASTE R UND SURFACE SOIL SLUDG <br /> <br />WATER WATER ATE WATER <br /> <br /> <br />OTHER (Specify): ~ <br />~ <br />;.w <br /> <br />s <br />r <br /> <br />~~~ <br />J <br />~' ~ <br /> <br />` `~' <br />~, <br /> <br />~~~~~ <br />~ ~' <br />'- <br /> <br /> <br />s <br /> <br />~~-~ ~' LGN <br /> <br /> <br />LOC <br /> <br /> <br /> <br />C <br />DATE TIME CLIENT SAMPLE ID: ~ j -.~, J u' ~_ ~ DISP <br /> <br /> <br />~'~ ~ ~ DUE <br /> -~ REPORT- RESULTS <br /> TO CDHi Y -. N_ <br />(DRS ~I ~ - <br /> PU~Li~'~:'A-~RSUPPLY,I~:~J° <br /> P'JSIG; <br /> -- - - - <br />• <br />' <br /> JA~.1E~ <br />~S <br />S <br /> AGGR~SS_ <br /> CIT'i iSTATE <br /> SIP. <br /> COiIN~`f <br /> <br />COMMENTS: DELIVERED BY: <br />RELINQUISHED BY DATE~rIME <br />~ /~ l>, ~~~~ RECEIVED BY DATE~rIME <br />-r b o s RELINQUISHED BY DATE/TIME RECEIVED BY DATE/ TIME <br />240 S. Main St. Brighton, CO 80601 (03) 659-2313 Mailing Address: P.O. Drawer 507 Brighton, CO 80601 <br />