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CHAIN OF STODY RECORD Laboratory Sample Numbers (ACZ User): �L—1 Co 8378 <br /> Name to Appear on Report and Invoice: cc: (Report) (Invoice) to: (circle one or both) <br /> ACMLaboratories, Inc. d v� <br /> 30400 Downhill Drive GCS � � Cd <br /> Steamboat Springs, CO 80487 Attn: Tel: Attn: Tel: g" <br /> 970 879-6590 800 334-5493 <br /> _Z v S <br /> Project or P.O. # ANALYSES REQUESTED <br /> TL 0 vo)_ o REMARKS <br /> JS�r�c t871, a <br /> Shipped Via: FED X UPS Hand Other 8 <br /> Same <br /> SAMPLE IDENTIFICATION DATE TIME Matrix <br /> s- 11. Sw g I L1 , <br /> I : . <br /> - tog - C.5 .50 Sly 8X , C mS <br /> *Matrix 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. -, '1�/l� J e) <br /> (A)Long-term storage (B)If Sample Is Non-Hazardous (C)If Sample Is Hazardous 1`� <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 /> RNLI QUIS Ep BY' (SIGNATURE) DAT TIME RECE ED : ( 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 /> 1.,'k <br />