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CHAIN OF CUSTODY RECORD <br />NOTES: <br />1) Ensure proper container packaging. <br />2) Ship samples promptly following collection. <br />3) Designate Sample Reject Disposition. <br />PO# <br />Table 1. - Matrix Type <br />1 = Surface Water, 2 = Ground Water <br />3 = Soil/Sediment, 4 = Rinsate, 5 = Oil <br />6 = Waste, 7 = Other (Specify) <br />Page of <br />FOR GAL USE ONLY <br />GAL JOB # <br />d% - I! <br />Project Name: d!i,cr ?" .',rc'?,a r? 1? <br />01 <br />02 <br />Oa <br />i <br />01 <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 M iscellaneous Preservative(s) <br />w <br /> <br /> o <br /> <br />Sample ID <br />Date <br />Time v v ? <br />Comments <br /> l~ F UO ? d <br /> V <br />•t. <br />R F. e. <br />. <br />O <br />Q <br />?r <br /> <br />c M <br />'n <br />.? <br />O <br /> <br />? <br />0 <br />N <br /> <br />? <br /> c <br />U .?t iL p <br />Z ? _ Z U <br />x c <br />x ? <br />Z 0 <br /> f 75 -7J <br /> <br />3. ac?? ?R 9 L+?j 'lid Z -2. <br /> <br /> <br />5. <br />6. <br />7. <br />8. <br />9. <br />10. <br />Relinquished b F?? Date: <br />Z Time: l <br />Received by Dat Time. <br />Relinquished by: Date: Time Received by. 0 Date: Tine- <br />* Sample Reject: [ ] Return [ ] Dispose [ ] Store (30 Days)