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9:?-NN Colorado Analytical <br />Laboratories, Inc. <br />CHAIN OF CUSTODY RECORD <br />COMPANY NAME: <br /> <br />VY CONTACT PERSON: <br />Colorado Analytical <br />Laboratories. Inc. <br /> <br />Drawer 507 <br />P <br />O LABORATORY <br />USE ONLY <br /> <br />039152 <br />N2 <br />ADDRESS: PROJECT 1D /DESCRIPTION: . <br />. <br />240 South Main Street <br />CITY/ST/ZIP:' ??t??: L p•?$.??? iiiG?? Le7 ?C'vS Brighton, Colorado 80601 <br />303-659-2313 <br />TELEPHONE: SAMPLED BY: FAX: 303-659-2315 LAB # OS 0 ! <br /> <br />FAX: P.O. NO.: TESTS RE QUE STE D <br />LGN <br />Sample Matrix (Circle One : <br />DRINKING WASTE GROUND SURFACE SOIL SLUDG <br />WATER WATER WATE WATER <br /> <br /> <br />OTHER (Specify): w. <br />Z <br /> <br />Z <br /> <br />O. <br />o J - <br />w <br />o .? <br />Y <br />w ,0 <br /> <br />:Q -j <br /> <br /> <br />.'. <br /> <br /> <br />o o z 4 <br /> <br /> <br />? --in <br />V <br />v <br />1 <br />LOC <br /> <br />r> <br />QC <br />DATE ( TIME CLIENT SAMPLE ID: <br />. <br />. c7` i <br />> V ?:;czi 2 <br />1 <br />S <br />U + <br />DISP <br />I <br /> <br />- <br />r7/ . <br />- <br />- - <br /> <br />UE <br /> D <br /> REPORT RESULTS <br /> TO CDH: Y oR _ . N <br />(DRINKING WATER ONLY):. <br /> PUBLIC WATER .SUPPLY INFOR: <br /> PWSID: <br /> ,- <br />SYS NAME: <br /> <br /> ADDRESS <br />.77 <br /> CITY/STATE <br /> ZIP. <br /> <br /> COUNTY: <br /> <br />COMMENTS: <br />DELIVERED BY: <br />RELINQUISHPQ B? ,? DATE/TIME n^ C fV ID J / D3)E/T.Ijt0q RELINQUISHED BY DATE/TIME RECEIVED BY DATE/ TIME <br />240 S. Main St. • Brighton, CO 80601 303) 659-2313 Mailing Address: P.O. Drawer 507 9 Brighton, GO 130601