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<br /> <br />Colorado Anal tical <br />'% <br />'Laboratorles, Inc. <br /> CHA IN OF CUSTODY RECORD <br />COMPANY NAME: CONTACT PERSON: <br />r '-'- J <br />C <br />l <br />d LABORATORY <br />d <br />A o <br />ora <br />o Analytical <br />Laboratories, Inc. USE ONLY <br />ADDRESS: ?a PROJECT ID / DESCRIPTION: P.O. Drawer 507 N2 039157 <br />/ / <br />CITY/ST/ZIP: rec? : L -& /6`7- 240 South Main Street <br />Brighton, Colorado 80601 <br />TELEPHONE: SAMPLED BY: --- <br />o3 3 l ?-i L? -???'F%? 303-659-2313 <br />FAX: 303-659-2315 . <br />LAB # ?? <br /> <br /> <br />FAX: P.O. NO.: <br />a <br />TESTS REQUESTED . <br />Sample Matrix (Circle O <br /> <br />n <br />J <br /> <br />!7A <br /> <br />LGN <br />DRINKING WASTE GROUND SURFACE SOIL SLUDG z o o t r, I? - <br />WATER WATE WATER i? MATER ¢ z. w <br />o <br />t ( w -14 '? A ? LOC <br />- <br />_' o <br />OTHER (Specify): <br />0 <br />m <br />a z Z <br />j N <br />QC <br />m <br />DATE TIME CLIENT SAMPLE ID: O CC <br />w i <br />`j s v „s <br /> <br />DISP <br />-_s ell <br /> DUE <br />44 <br />Ole C <br />)c X O <br />C Gl qcd CO-' 41-4 <br />' 5< K IC REP <br />RT RESULTS <br />TO CDH: Y N <br />?' ?,?" ?• 4 <br />-?? ??i t? ?c'?' 7 t _ v y? (DRINKING WATER ONLY) <br /> <br />yc PUBLIC WATER SUPPLY INFOR: <br />Li '.3 <br />s c, G I x <br />,?-, <br /> <br />x <br />L <br /> <br /> <br /> <br />WSID: <br />30 1 itG SYS NAME: <br /> ADDRESS: <br /> CrrY/STATE: <br /> ZIP: <br /> COUNTY: <br /> CO?MMENTS: <br />1J• ???' ?.1/P ?t Eti''t''C?r J DELIVERED BY: <br /> RELINQUISHED BY DATEMME EC <br />IVED BY <br />Eaf IM <br />? 3 - <br />RELINQUISHED BY <br />DATE/TIME <br />RECEIVED BY <br />DATE/ TIME <br /> `fly l? f <br />6;1 <br /> l <br />2? <br />240 S. Main St. • Brighton, CO 80601 • 30 659-2313 Mailing Address: P.O. Drawer 507 9 Briahton. 00 Rnrni