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i <br /> CHAIN dIMSTODY RECORD Laboratory Sample Numbers (ACZ WWI* <br /> Name to Appear on Report and Invoice: cc: (Report) - (Invoice) to: (circle one or both) <br /> ACZLaboratorles, Inc. glybdin <br /> 30400 Downhill Drive <br /> t Cd Steamboa Springs,s CO 80487 <br /> p 9 ' "� : _ <br /> (970) 879-6590• (800) 334-5493 Attn: Tel Attn: Tol:, - <br /> Project or P.O.# -rt— ANALYSES REQUESTED <br /> CC Co�a`� W REMARKS <br /> ss//V1C !82P I <br /> l Shipped Via: FED X_UPS Hand Other <br /> SAMPLE IDENTIFICATION DATE TIME S m�fe <br /> Pe— <br /> i(10/AA2J <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 BAND C. s- 7'� <br /> Proper charges will be assessed. <br /> (A)Long-term storage (B)H Sample is Non-Hazardous (C)If Sample to Hazardous )V In�L'`t <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 /> RELIN UISHED BY: (SIGNATURE) DATE TIME REC IV BY ( SIGNATURE) DATE TIME PAGE <br /> �6 <br /> O <br /> T <br /> White-Return w/sample Yellow-Return w/sample Pink-Return w/sample Gold Keep for your records <br />