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Analytical <br />Laboratories <br />Client: L e <br />Contact: e7Q /5 !2 /0 <br />Address: 6 y 7 3 ?ZC3 <br />tl?S??'/Lc-r S ?o ?1r3?2? <br />Phone Number: 9.70 . V.5, C/?Z O <br />FAX Number: , Ylo 3 <br />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 />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?r?. <br />PO# <br />Page I of I <br />FOR GAL USE ONLY <br />GAL JOB # <br />•00(0 <br />Project Name: k,A16 Z ? k-"Va zz- Samplers Signature: <br />Lab Name: Green Analytical Laboratories (970) 247-4220 FAX (970) 247-4227 Analyses Required <br />Address: 75 Suttle Street, Durango, CO 81303 <br /> <br /> Colle ction Miscell aneous Pre serv ative(s) <br /> <br /> e <br /> Z <br /> ° <br /> <br />Sample ID <br />Date <br />Time ?. v <br />Comments <br /> ETH U k i <br /> E <br /> U o <br />ti Z f% x x x Z C <br />l.w [C7Z? ??"G L /2C Q 2- Z ? <br /> <br />2.,0.! u A I??v7 ?? o q 6 2 2 <br />3?2 O?cdtJ OFD/? 1l 2G O 4° TB Z 'Z ? ? <br /> <br />4.?u /c(4adCC/1 ?R <br />Z <br />Z / <br />l <br />C7 <br />A <br />P L ?,?j <br />6o rT K 5 S <br />5. <br />6. <br />7. <br />8. <br />9. <br />10. <br />Relinquis d Date: Time: <br />' Received by: <br />/ Date: Time: <br />Aw4 l.Z I A <br />- <br />2-fl <br />/ <br />Relinquish by: Date: Time Received by: Date: Time: <br /> <br />* Sample deject: [ ] Return [ ] Dispose [ ] Store (30 Days)