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§2479 River Road, Unit A u IM J <- • 0001, 040 <br />Gra d Junction, Co, a1505- <br />(970) 2435311 <br />Fax (970) 243-6010 p /y I <br />Prni Aln r .............. s .. i `' 170...1 ?7?.y!"?^Cr t.LK1-'?S YI t-V1,--c4 y-L, <br />CHAIN OF CUSTODY RECORD <br />o"?/l In//-7n-2 <br /> Phone # SA MPL E A NAL YSE S <br />w <br />xc <br /> <br /> <br />Fax #,t?. ' l ` ?( 31 Z a <br />w uj w <br />a- <br />a- <br />PJ?ER?: (Sign re) PRINT NAME ? <br /> : N <br /> <br />> <br /> <br />REMARKS a <br />u) <br /> <br /> <br /> <br />AMPLE NO <br /> <br />. <br /> <br /> <br />ATE <br /> <br /> <br />IME <br /> <br /> <br />ATRIX -- <br /> <br /> <br />PROJECT NAME/ w <br />z <br /> <br />F <br /> <br />w <br /> <br />0 <br />a <br /> <br />SAMPLE LOCATION Z <br />0 a O <br />Co <br /> U g <br /> /0 &o <br />c <br />n. <br />s - ter /004 <br /> <br /> <br /> <br />f i /00 <br />.. t? <br />5 <br /> <br /> <br /> <br />- ? ri r ti <br />1 <br />?> / _ <br />0 <br /> <br /> <br /> <br /> <br />I- TOTAL NO. OF CONTAI NERS 12 <br />elinquisshe by : (Signature) Date / Time Receiv d by (Signature) <br />_ Relin uis d b <br />q y: (Signature) <br />Date/Time <br />Received by: (Signature) <br />C <br />d <br />usto <br />y Seal No. C ody Seal Date equired <br /> Present a <br /> <br />Method of Shipment: Intact a <br />Shipped by: (Signature) <br /> <br />Date Completed: <br /> <br />Received for Laboratory by: <br />In t re), <br /> <br />Da a /Time <br />7 3 <br />? <br /> <br />IMS • <br />E 10? /Z <br />.,,,y--- -vl1lpalies anipmenr, copy to Field Files <br />Form CC-01-6-92 Rev. 7/97 <br />-------- --------- <br />r <br />u <br /> <br />