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Laboratory Sample Numbers (ACZ Use Only): COC# <br /> CHAIN OF CUSTODY RECORD Pv o TS ,?V ' 7� 4 5 g <br /> Name to Appear on Report and Invoice: cc: (Report) - (Invoice) to: (circle one or both) <br /> 'hin &7V1ran C r i <br /> ACZLaboratorles, Inc.30400 Downhill Driv <br /> Steamboat Springs, CO 80487 <br /> (970) 879-6590• (800) 334-5493 Attn: Tel: 03 d�. 10- g5oZAttn: TeL <br /> Project or P.O. # ANALYSES REQUESTED <br /> ir REMARKS <br /> Shipped Via: FED X_UPS Hand Other_ <br /> MPLE IDENTIFICATION DATE TIME to <br /> 5Ul_ 1 SZ / ;oo sw x x x <br /> -a <br /> SW -3 s 1;-<3o SW S X X X X <br /> sl »;oo 1 sw f x <br /> s ;yS �W Y, xX <br /> trix Options: SW(Surface water)•GW(Groundwater)•WW(Wastewater)•DW(Drinking water)•SL(Sludge)•SOIL•OIL•Other(Specify) COMMENTS <br /> SAMPLE DISPOSAL OP77ONS-Please complete section A, or choose one option from sections B AND C. • tA o k /90 6 <br /> kri­ <br /> Proper charges will be assessed <br /> (A)Long-tens storage (B)If Sample is Non-Hazardous (C)If Sample Is Hazardous <br /> Hold until (date) 1) Local Disposal 1) RCRA-Permitted Facility . <br /> for future analysis. ) �•Q <br /> RCRA-Permitted Facility 2) Return to Client <br /> 3 0 /� <br /> 3 Return to Client • GK. �1 6ynA '"_-"^•'�^'I <br /> RE QUISHED BY: (SIGNATURE) DATE TIME RECEIVED BY: ( SIGNATURE) DATE TIME PAGE# <br /> s L1 l :3 <br /> b OF <br /> Whit rn w/sample Yellow-Return w/sample Pink-Return w/sample Gold-Keep for y onis <br /> is <br />