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<br />Analytical <br />Laboratories CH?,IN OF CUSTODY RECORD <br />Client:: <br />NOTES: Page , of <br />i <br />Contact: ; . , y 1 //Z <br />1) Ensure proper container packaging. <br />Table 1. -Matrix Type <br /> <br />Address: a" <br />2) Ship samples promptly following collection <br />I = Surface Water, 2 = Ground Water FOR GAL USE ONLY <br /> . <br />3) Designate Sample Reject Disposition. <br />3 = Soil/Sediment, 4 = Rinsate <br />5 = Oil GAL JOB # <br />Q <br /> <br />Phone Number: <br />x l ? <br />PO# , <br />6 = Waste, 7 = Other (Specify) 03 -©t? <br />FAX Number: _.3 S - j/ 5 Project Name:A"(/-)d j 's;IbI <br />f \ <br />Samplers Signature: <br /> <br />Lab Name: Green Analytical Laboratories (970) 247-4220 FAX (970) 247-4227 Analyses Required <br />Address: 75 Suttle Street, Durango, CO 81303 <br />Collection Miscellaneous Preservative <br />(S) <br /> <br /> z <br /> <br />Sample ID Date Time <br /> Q- Comments <br /> <br />y 1- .2 C6 Cn <br /> a w z v, x z p <br />1.itsr4? w C 3 A <br />46 i? O-: ee a,-. ?y5 Z -Z A <br />- <br />3,1510 9 ?? <br />?rJ - <br />x1 ja <br /> _4 + vim. <br />ate- % O?Yi i <br />Z f? ` <br />5. <br />6. <br />7. <br />8. <br />10.E <br />r <br />Relinquished by7- -- Da1e <br />Relinquished by: - Date: <br />w <br />cr Keeeived by: <br />Received by: <br />.: * Sample ?t: [ ]Return [ ]Dispose [ ]Store (30 Days) • <br />..