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CHAIN OF CUSTODY RECORD <br />NOTES: <br />1) Ensure proper container packaging. <br />2) Ship samples promptly following collection. <br />3) Designate Sample Reject Disposition. <br />PO# <br />Table 1. - Matrix Type <br />1 = Surface Water, 2 = Ground Water <br />3 = Soil/Sediment, 4 = Rinsate, 5 = Oil <br />6 = Waste, 7 = Other (Specify) <br />Project Name: 1/NE 1 ?i?tJ S; <br />Page / of / <br />FOR GAL USE ONLY <br />GAL JOB # <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 /> Colle ction Miscel laneou s Pr eservativ e(s) J <br /> <br /> z <br />? <br />o <br />Sample ID Date Time <br />Continents <br /> ° <br />U w a 4 <br /> <br /> U w Z v? x x x z 0 <br /> 1?1?? i <br />2. raf'aa4, ,`v G 3r ?? <br />3. <br />J!t <br />Z 04C "A <br />'1 ? <br />2 <br /> <br />J <br />X <br /> <br />4 <br />43i%1Q . Gr"v< CH Mire <br />49 C U k <br />3' : <br />Z <br />Z <br />I v <br />5. <br />6. <br /> h <br />7. <br /> Sn <br />8. <br /> <br />10 <br />l q ed by: _ <br />L Da Ti : D Received by. <br />Date: <br />Time: <br />q <br />uished <br />by <br />HA <br />• <br /> <br />D <br /> <br />^ <br />7?Z-0 Z <br />, <br />q <br />( ate. me: <br />I xeceived by: Date: I 1 ime: ' <br />- ` Analytical <br />+ T 3ampte xeject: 11 xeturn 11 Dispose L J Store (30 Days)