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CHAIN OF NSTODY RECORD Laboratory Sample Numbers (ACZ Use i y 5 s COC AR 1 8 6 3 <br /> Name to Appear on Report and Invoice: . cc: (Report) - (Invoice) to: (circle one or both) <br /> ALaboratories, Inc. � <br /> 30400 Downhill Drive <br /> Steamboat.Springs, CO 80487 Attn: Attn: Tel: <br /> (970) 879-6590•(800) 334-5493 <br /> Project or P.O.# ANALYSES REQUESTED <br /> REMARKS <br /> W <br /> Z <br /> Z <br /> Shipped Via: FED X_UPS Hand Other ' <br /> SAMPLE IDENTIFICATION DATE TIME <br /> '1 <br /> r <br /> 1i <br /> •Matrbt Optf , . 5W(Surface water)•OW(Ground water)•WW(Wastewater)•DW(Drinkinga-&� )•SOIL•OIL•Other(Specify) COMMENTS <br /> MPLE b)SPOSAL OPTIONS-Please complete section A, or choose one option trod° sections B AND C. <br /> �s To-T <br /> Proper charges will be assessed. l <br /> (A)Long-term storage (B)N Sample/s Non-Hazardous (C)If Sample/s 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 /> Ilr' 3) Return to Client t <br /> RELIN UISHED BY: (SIGNATURE) DATE TIME RECEIV D BY: ( SIGNATURE) DATE TIME 'PAGE# <br /> r � 74 a <br /> OF <br /> I White•Return w/sample Yellow-Return w/sample Pink-Return w/sample Gold-KPep for your records <br />