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¦ <br />¦ <br />r <br />2479Rlver Road, UnrtA C ?`?? ' ???Q?. mow( .eat <br />Grand Junction, CU 81505 <br />(970) 243-5311 <br />Fax (970) 243-6010 z <br />-- Proi No r nl ? ? .. C?i"{r Ca+%??S?evlii c.om <br /> <br />CHAIN OF CUSTODY RECORD <br /> <br />Phone,, <br />Ct?p 'LW ( ]i63G SA MPL E A NAL YSE S <br /> <br />w <br /> Fax u U) <br />SAMPLERS: (Signat e) PRINT NAME: > <br /> <br />> 7KS <br />SAMPLE N0. DATE TIME MATRIX PROJECT NAME/ ¢ w <br />Co <br /> SAMPLE LOCATION z a 0 <br />m <br /> U <br /> <br />q 51 - ` 2 g <br />q,- <br />.9 to <br />k z,. <br />T <br />P <br />9?- 07( ., U._ O <br />, <br /> <br /> <br />J% - zr6A ( <br />W? <br />-7 <br /> <br />- <br />NH. 55 r <br />I6 <br />to <br /> <br /> <br />S _7,31 <br /> 1 <br />{4 S5 -237.4 <br /> ? /vz? <br /> <br /> <br /> <br />AS? ' - 2.35% I <br />N SS - 2 5 <br />I <br /> 41- t plc <br /> TOTAL NO. OF CONTAI NERS <br />Relinquished by : ( nature) Data / Time Received b <br />Y? (Signature) <br />lin 'she by: (Signature) <br />Date /Time Received by: (Signature) <br /> <br />Custody Seal No. Gust Y Seal <br />DAte Required <br /> Present n <br /> <br />Method of Shipment: Intact <br />Shipped ba <br />Y? (Signature) <br /> <br />Date Completed: Received for Laboratory by: <br /> <br />D to /T- <br /> i ature) <br />i <br />7 <br />r <br />___...?_......, ,,•..r??.o?,,, -Py w ri- rues <br />Form CC-01-6-92 Rev. 719 7