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Analytical <br />Laboratories <br />Client: <br />Contact: Rio.a V'ww--,fp <br />Address:f jji? Q?tJlfc/`1 ?vtiZr?ltri- <br />n W-(, Co low <br />_ <br />Phone Number. 'S03 -131.1- G <br />FAX Number. <br />• <br />CHAIN OF CUSTODY RECORD <br />NOTES: <br />1) Ensure proper container packaging. Table 1. - Matrix Type <br />2) Ship samples promptly following collection. I = Surface Water, 2 = Ground Water <br />3) Designate Sample Reject Disposition. 3 = Soil/Sediment, 4 = Rinsate, 5 = Oil <br />PO# 6 = Waste, 7 = Other (Specify) <br />Project Name: L--f L OC. 4. it Samplers Signature: <br />• <br />Page t of '2- <br />FOR GAL USE ONLY <br />GAL JOB # <br />/Vo's_o'7a <br />1(q <br />J 7 <br />Lab Name: Green Analytical Laboratories (970) 247-4220 FAX (970) 247-4227 Analys es R equired <br />Address: 75 Suttle Street, Durango <br />CO 81303 <br />, <br /> Colle ction Mi <br />ll y <br /> sce <br />aneous Preservative(s) <br /> <br /> <br />Sample ID Date Time <br /> <br /> <br /> <br />U <br /> <br />.0 <br /> <br />E~? <br />F' <br /> <br />0 <br /> <br />U <br /> <br /> <br />? <br />v <br /> <br /> <br />v Comments <br /> U ?C 4.. 0 M 0 x U <br /> o <br />z ti <br />x <br />x z o Z J <br /> kn a ` N <br /> <br />3. <br />4 <br />. <br />5. <br />6. <br />7. <br />8. <br />9. <br />10 <br />. <br />Relinquished by: Dat <br /><O <br />Tile ? <br />` <br />Received by l <br />Date <br />Time: <br /> <br />Relinquished by. <br />Date: <br />Time: <br />Received by. _ O <br /> <br />Date v <br /> ,me: <br />00A" 11G A-'+JH " t i 1\V-- L i --PuSe 1 i zaore t.5v nays)