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^1 <br />• 'b-, Colorado Anal tical <br />Laboratories, Inc. <br />CHAIN OF CUSTODY RECORD <br />COMPANY NAME: <br />?n? <br />it ?JI d ms?Nl <br />6 CONTACT PERSON: <br /> <br /> <br />'uu 6 <br />Colorado Analytical <br />Laboratories, Inc. <br />P <br />D <br />507 <br />O LABORATORY <br />USE ONLY <br /> <br />ADDRESS: WD <br />PROJECT ID /DESCRIPTION: <br />. <br />. <br />rawer <br />240 South Main Street N 041028 <br />CITY/ST/ZIP: Brighton, Colorado 80601 <br />303 <br />659 <br />2313 <br />TELEPHONE:SCB- g;35--) 4't SAMPLE BY: ' ?? ? - <br />- <br />F <br />AX: 303-659-2315 7 < <br />?SSC? / 5/ <br />LAB # <br /> <br />FAX: P.O. NO.: TESTS REQUE STE D <br />Sample Matrix (Circle One): <br />DRINKING WASTE GROUND SURFACE SOIL SLUDGE <br /> <br />WATER WATER WATER WATER <br /> <br />OTHER (Specify): <br />LLr <br />Z <br /> <br /> <br />o-: J <br /> <br />° . <br />o 'Lu <br /> <br />Q <br /> <br />Q., <br /> <br />LLJ LGN <br /> <br />LOC <br /> <br /> <br />QC <br />DATE TIME CLIENT SAMPLE ID: O 0 D1SP <br /> <br /> <br /> DUE <br />f Y <br />l <br /> <br />J% <br />? <br />7 6 <br />t '?LJ <br />` <br />REPORT RESULTS <br /> TO CDH: Y E N <br />(DRINKING WATER ONLY) <br /> <br /> PUBLIC WATER SUPPLY INFOR: <br /> PWSID <br /> : <br /> SYS NAME: <br /> ADDRESS: <br /> CITY/STATE: <br /> ZIP: <br /> <br /> COUNTY <br /> <br />COMMENTS: DELIVERED BY: <br />RELINQUISHED BY DATE/TIME REC.?IVED BY DATE/TIME RELINQUISHED BY DATE/TIME RECEIVED BY DATE/ TIME <br />240 0000"W441444"164444W4.40??WIWIv` *644rowo?`