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Laboratory Sample Numbers(ACZ Ut ly): 71Y. <br /> .L �� <br /> CHAIN l.. ,CUSTODY RECORD Ca,, 12 0 9 0 <br /> Name to Appear on Report and Invoice: cc: (Report) - (Invoice) to: (circle one or both) O <br /> ACZI.aboratorles, <br /> Inc. <br /> 30400 Downhill Drive Q1 <br /> Steamboat Springs,CO 80487 <br /> (970) 879-6590•(800) 334-54943 Attn: Tel: - Attn: el:. <br /> Project or P.O.# /_��� ANALYSES REQUESTED <br /> t� 17 REMARKS µ <br /> z <br /> Shipped Via: FED X_..UPS_Hand_Other <br /> SAMPLE IDENTIFICATtON DATE TIME Mom: <br /> la 7im <br /> z <br /> z <br /> c <br /> ✓ Il r \./I V 3 <br /> Z <br /> r- <br /> •Mottk Optlons: SW(Surfaoa water)•GW(Ground water)•WW(Waslewaler)•DW(Drinking water)•SL(sludge)•SOIL-OIL•other(Speolly) COMMENTS <br /> SAMPLE DISPOSAL OPTIONS-Plesse complete section A, or choose one option from sections a AND C. / <br /> Proper charges will be assessed. <br /> ( fAng-tern storage (B) if Sample Is Non-Hazardous Xj It Sample is Hazardous �jday ]� <br /> I� <br /> 01) <br /> Hold until (date) 1)Local Disposal 1)RCRA-Permitted Facility /4 r _' cA <br /> for future anaiyals. 2)RCRA-Permitted Facility 2)Retum to Client /'') ko <br /> 3)Return to Client // rl.G[,[GC(/ l.ir�f �� ►�- m <br /> REL1N U1SHE BY: (SIGNATURE) DATE TIME RECEIVED BY: (SIGNATURE) DATE TIME PAGE# <br /> m m <br /> N <br /> WMe-Return wl sample Yellow-Ratum wl sample fink•Return w/sample Gold-Keep for your records <br />