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I'?1 <br />• '? Colorado Analytical <br />Laboratories, Inc <br />CHAIN OF CUSTODY RECORD <br />COMPANY NAME: _ CONTACT PERSON: <br />LABORATORY <br />Colorado Analytical USE ONLY <br />? Laboratarles, Inc. <br />ADDRESS: Gy ?, PROJECT I/ DESCRIPTION: P.O. Drawer 507 N 2 037409 <br />240 South Main Street <br />CITY1ST21P: ;e/,,-P, e& (o eom, h;v7 4-7ica- dE Brighton, Colorado 80601 <br />TELEPHONE: 303-659-2313 <br />-g0.? SAMPLED BY: - ?? FAX: 303-659-2315 <br />FAX: V LAB # <br />P.O. NO.: TESTS REQUESTED <br />Sample Matrix (Circle One)----? 5? LGN <br />DRINKING WASTE GROUND SURFACE SOIL SLUDGE <br />WATER WATER, W WATER Y`? a LOC <br />OTHER (Specify): o of ¢ ?`? <br />QC <br />U- Z <br />DATE TIME CLIENT SAMPLE ID: rJ O'S ¢j DISP <br />- 1:1" 4z <br />cle <br />(- l' ?p_yvt ??? _ DUE <br />t I X13 G,?wl we C P <br />REPORT RESULTS <br />lGg1I L ?'( 7O CDH Y <br />-77 N <br />,,vGJ j? (DRINKING WATER ONLY) <br />bsL.r ( r /' PUBL, C' WATER SUPPLY INFOR: <br />F 3 3?' k PWSIM <br />1Z Alk n <br />SYS NAME <br />.?? . ADDRESS <br />CITY/STATE: <br />ZIPcAl V-1 (,Val <br />eouNTY. _ <br />COMMENTS- DELIVERED BY: <br />I'S -C re <br />RELINQU HED BY DATE/TIME RE IVED BY f: D TE/TIM v RELINQUISHED BY DATElTIME RECEIVED BY DATE/TIME <br />l? I L <br />240 S. Main St. • Briahton. CO 806101 • fR ) FR..rq-g.'g1R RAailinn Arirlrocc- pn nr-n%aior CZ07 • Rr;nh+r%" rn 4ncni <br />••••••••••••••••••••11111111111 II II II II II II II II II