Laserfiche WebLink
Analytical <br />Laboratories <br />Client: rgry;1, -*, <br />Contact: A..,,,(\ A 6 <br />Address: W,SS' ;<_ 0,f A.K,-b,kI-t Suite Cana-Yf <br />Phone Number. -:ZS:? 3??,2 , 66 tf _ <br />PAX Number. <br />Lab Name: Green Analytical Laboratories <br />Address: 75 Suttle Street, Durango, CO 81303 <br />Collection <br />Sample ID <br />T 2.? _ <br />01 1 <br />/0 5. <br />1 y 6.?--? <br />Date Time <br />L 10 [ ?y <br /> 1'+ao <br />? ?° D 3Sa <br /> Iz? <br /> <br />IL tti oa3a <br /> <br /> Cl Ler <br /> <br /> <br />?J <br />CHAIN OF CUSTODY RECORD <br />NOTES: <br />1) Ensure proper container packaging. Table 1. - Matrix Type <br />2) Ship samples promptly following collection. 1 = Surface Water, 2.= Ground Water <br />3) Designate Sample Reject Disposition. 3 = SOWSediment, 4 = Rinsate, 5 = Oil <br />PO# 6 = Waste, 7 - Other (Specify) <br />Project Name:1VDur?T Samplers Signature: <br />(970) 247-4220 FAX (970) 247-4227 <br />Miscellaneous <br />y <br />it <br />V ? <br />o F?' 0 0 <br />o ? o c <br />U_w z <br />xellnquidied by: <br />* Sample Reject: [ ] Return [ ] Dispose [ ] Store (30 Days) <br />3 <br />Preservative(s) <br /> <br /> O <br />h <br />fJ <br />ti <br />N <br />". 'D <br />y <br />v <br /> <br /> <br /> w x z o <br />I by. <br />y: <br />5b <br />Analyses Required <br />? J <br />1- <br />tiC K <br />• <br />Page--4_ of-?- <br />FOR GAL USE ONLY <br />GAL JOB # <br />/ C10 $- o <br />Comments <br />0 <br />Time.