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Analytical <br />Laboratories <br />CHAIN OF CUSTODY RECORD <br />Client: act' <br />Contact: <br />Address: 6y7 3 , /? i 2 (? <br />Phone Number. 7 f- YS Z g Jc ?$ o <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 (Spec' <br />FAX Number. 70 3R4i -YG 3 Project Name: & <br />PLr=.tS ? /,c.Jr1a rG L ?dov?lr-•?? ? <br />Page___/ _ of -L <br />FOR GAL USE ONLY <br />GAL JOB # <br />/eat- c :7G <br />Lab Name: Green Analytical Laboratories (970) 247-4220 FAX (970) 247-4227 Analyses R equired <br />Address: 75 Suttle Street, Durango, CO 81303 <br /> Collection Miscellaneous Preservative(s) <br /> <br /> <br /> O <br /> v <br />Sample ID Date Time Comments <br /> x E. e? et <br />? <br /> v <br />a, w. <br />o ai <br />a rn <br />O U 0 O <br />: <br />1 <br /> U ct z r ? x x w Z O <br />1. wIGTZaG Lr? L L 2:1G= Z L) K AC A.J< <br />2.?' 6 _R EitfT 2. I ?J Z Z lCf iV 6 JT <br /> <br /> <br />5. <br />6. <br /> <br />fi. <br />9. <br />10. <br />Relinquished by Date r3 Time: Received by - Date: Time: <br />Relinquished by: Date: Time: Received by: Date :Time: <br />M <br />o'L <br />03 <br />oy <br />* Sample Reject. [ J Return [ J Dispose ( J Store (30 Days)