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All, Amk <br /> MW <br /> CHAIN OF CUSTODY RECORD Laboratory Sample Numbers (ACZ Us tly): D(,t wi JCOCT1 1468 <br /> Name to ppear on Report and Invoice: cc: (Report) - (Invoice) to: (circle one or both) <br /> AraZI-aboratorles, Inc. <br /> 30400 Downhill Drive 7 <br /> Steamboat Springs, CO 80487 Tel; Attn: <br /> (970) 879-6590• (800) 334-5493 <br /> Attn: <br /> Project or P.O. # ANALYSES REQUESTED <br /> C &AV a REMARKS <br /> w <br /> �u✓�' a <br /> Shipped Via: FED X_UPS Hand Other c°� <br /> SAMPLE IDENTIFICATION DATE TIME I Sample <br /> Matnx <br /> ' <br /> NIV If �. <br /> _gyp <br /> 8( <br /> yir <br /> ` 14 <br /> 1 - <br /> *Matrix Options: SW(Surface water)•GW(Ground water)•ww(Wastewater)•DW(Drinking water)•SL(Sludge)•SOIL•OIL•Other(Specify) COMMENTS <br /> SAMPLE DISPOSAL OPTIONS-Please complete section A,or choose one option from sections B AND C. J,, /Jy�► , y <br /> Proper charges will be assessed. <br /> eXh��LC�+/ , . <br /> (A)Long-term storage (B)If sample is Non-Hazardous (C)If Sample Is Hazardous <br /> t Local Disp <br /> osal <br /> al 1) RCRA-Permitted Facility r <br /> Hold until (date) ) �_ permitted Facility <br /> for future analysis. 2) RC 2) Return to Client <br /> 3)Return to Client C.LG <br /> RELINQ ISHED BY: (SIGNATURE) DATE TIME ;i RECEIVED BY: ( SIGNATURE) DATE TIME PAGE# <br /> 3-110T - <br /> i OF <br /> �r <br /> Yellow-Return w/sample nk- n w/Sam le -r--- <br /> White-Return vul sample V Gold-Keep for your records <br />