Laserfiche WebLink
1 <br /> CHAIN O USTODY RECORD Laboratory Sample Numbers (ACZ Us ly): L)3 3 Lf� COC# $ 15 5 <br /> Name to Appear on Report and Invoice: cc: Report (Invoice) to: (circle one or both) <br /> A Laboratories, Inc. , <br /> 0r7 h'd <br /> 30400 Downhill Drive / AA sid- Z'd <br /> �ft <br /> Steamboat Springs, CO 80487 rwm lewood K0 It,L <br /> (970) 879-6590• (800) 334-5493 Attn: Tel: 7l q 406-Z15-O Attn: -,SvnTel:31J3_ 0_ g <br /> Project or P.O. # ANALYSES REQUESTED <br /> 7W-C, 45,/6a -001 <br /> W REMARKS <br /> .��M C. )8 7--b k hcl�de ammon�c� -Fc-am III <br /> Shipped Via: FED X UPS Hand Oth r_ <br /> � r�vA g•�, q�� <br /> SAMPLE IDENTIFICATION DATE TIME Ma nZe <br /> M � <br /> APR q•s /9:etl sw <br /> CPA - A 0 1 12:/0 SIA <br /> P — b 6w <br /> 01- <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. <br /> Proper charges will be assessed. <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 JSAN4L 1,57 <br /> for future analysis. 2) RCRA-Permitted Facility 2) Return to Client ��� 1���7 <br /> 3 Return to Client 4 <br /> REI ! QUISH BY: (SIGNATURE) DATE TIME RECEIVER BY: ( SIGNATURE) DATE TIME PAGE# <br /> OF <br /> White-Return w/sample Yellow-Return w/sample Pink-Return w/sample Gold-Keep for your records <br />