Laserfiche WebLink
M Inter-Mountain Laboratories, Inc. '-CHAIN OF CUSTODY RECORD <br />S"ridan,. WY and. GiNette,..WY- Thisis a. LEGAL-DOCUMENT;-All shaded fields muh be comnlefed - .. ... .. .§ - . <br />INTER-MOUNTAIN LABS <br />Client Name f. r < ,'. <br />r„ Project Identification Sampler (Signature/Printed) _ Telephone # <br /> l s ; jfr_ ~ <br />Report Address Contact Na <br />me and Email ANA LYS ES / PARAME TER S <br /> Voice = r' - <br /> <br />Invoice Addross <br />,, ,.. <br />, <br />FAX r <br />._ <br /> • <br />, <br />- r' ' - _ -_ - Purchase Order # Ouote # <br /> <br /> <br />w LAB ID DATE TIME SAMPLE # of REMARKS <br />I_ (Lab Use Only) SAM PLED IDENTIFICATION Matrix Containers <br /> <br /> <br /> <br /> r <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />UPS Water _VJlL ' Check desired service Compliance Monitoring ? <br />? Fed Express Soil SL -LJ;Standard turnaround Program (SDWA <br />NPDES <br /> <br />? US Mail <br />Solid SD , <br />, <br />U RUSH - 5 Working Days PWSID / Permit # <br />L3 Hand Carried Trip Blank TB J URGENT- < 2 Working Days Chlorinated? y / N <br />roc ?.: ! 1 <br />? Other Other OT Rush & Urgent Surcharges will be applied Sample Disposal: Lab _ Client .; ' <br /> <br />Rev 4.3