Laserfiche WebLink
CHAIN OF STODY RECORD Laboratory Sample Numbers (ACZ Use �): 3-� 1COCff 7125 <br /> Name to Appear on Report and Invoice: c (Repo (Invoice) to: (circle one or both) <br /> r <br /> Laboratories, Inc. --Ll IM&x M oN bd. no m a n�, a t r <br /> ACZ30400 Downhill Drive <br /> 30 <br /> $�d 4 <br /> Steamboat Springs, CO 80487 <br /> (970) 879-6590- (800) 334-5493 Attn: Tel: I %0- d ISd Attn: Tel: 303.85-0- s; <br /> Project or P.O. # ANALYSES REQUESTED <br /> u w,a",W A-� w d;Z, ca REMARKS <br /> R <br /> z <br /> Shipped Via: FED X. UPS Hand <br /> pp Other_ <br /> U <br /> w <br /> SAMPLE IDENTIFICATION DATE TIME Sample <br /> Matnx <br /> E1DR <br /> s l9 <br /> tlo - 13; o -SW g <br /> CPR - C 1:00 Sw 9 <br /> • atrix Options: SW(Surface water)•GW(Groundwater)•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. C a US'M g <br /> Proper charges will be assessed. otk <br /> (A)Long-term storage (B)If Sample Is Non-Hazardous (C)If Sample is Hazardous <br /> Hold until (date) 1) Local Disposal 1) RCRA-Permitted Facility <br /> for future analysis. 2) RCRA- Permitted Facility 2) Return to Client <br /> 3) Return to Client <br /> RED. UIS Y: (SIGNATURE) DAT TIME RECEIVED BY: ( SIGNATURE) DATE TIME PAGE# <br /> /v:ov <br /> OF <br /> White-Return w/sample Yellow-Return w/sample Pink Return w P /sample Gold Keep for your records <br />