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• <br /> Laboratory Sample um y):Sle Numbers (ACZ Use " '` <br /> CHAIN O STODY RECORD ;`' ' ;., ��� �, GOC ' ' <br /> 3 <br /> Name to Appear on Report and cc Report (Invoice) to: (circle one or.both) <br /> AUZ <br /> Laboratories, Inc. < ' �� a ,c< ur. ' Z �o <br /> 30400 Downhill Drive _ , �.- <br /> Steamboat Springs, CO 80487 <br /> Attn: Tel: Attn: 8So(970) 879-6590 (800) 334-5493 <br /> Project or P.O.# ''ANA YSES REQUESTED <br /> jG 1plDo?-Q!Q/ REMARKS <br /> ' a <br /> Shipped Via: FED X UP ' Hand Other <br /> PPe �. . S — $ <br /> SAMPLE IDENTIFICATION DATE TIME Samx' <br /> DA <br /> R: A 3 1520 :o <br /> pR - 3 Rep 1:010 <br /> P - SW ,wAl �,44jjjr. <br /> -P :50 1 5 <br /> w <br /> 6. <br /> i • <br /> •Matrbc OpUons: SW(Surface water)•GW(Groundwater)•WW(Wastewater)•DW(Drinking water)•SL(Sludge)•SOIL•OIL•Other pecily) " ' MM ENTS <br /> SAMPLE DISPOSAL OPTIONS-Please complete section A,or choose one option from sections WAND C. <br /> Proper charges will be assessed. ,y <br /> (A)Long-term storage (8)N Sample(a NQ»µlainrdous (C)If Sample Is Hazardous - <br /> Hold until (date) 1)Local�Disposal . K; 1) RCRA-Permitted Facility L(//M <br /> for future analysis. ` ; `' 2) RCRA-Permitted Fa .y'� 2) Return to Client <br /> "7�' A' <br /> 3)Return to Client <br /> RE UIS E Y: ( IGNATURE) DATE TIME R EIVED Y: ( SIGNATURE) DATE TIME PAGE# <br /> ov <br /> OF <br /> i <br /> White•Return w/sample Yellow-Return w/sample Pink• eturn w/sample Gold-Keep for your records <br />