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Analytical <br />Laboratories <br />Client: Cy?- i'kCkZr- -(lzI la . S <br />Contact: ?G (? . "? f 2 g.? tea <br />Address: ?0 M a K (e' i(- <br />_Phone Number: 9 X7 Z"Z <br />FAX Number: 'XJ6 7 " ? 2- -Z4 <br />CHAIN OF CUSTODY RECORD <br />NOTES: <br />1) Ensure proper container packaging. <br />2) Ship samples promptly following collection. <br />3) Designate Sample Reject Disposition. <br />PO# <br />Project Name: <br />Page-1- of <br />Table 1. - Matrix Type FOR CAL USEONLV <br />1 = Surface Water, 2 = Ground Water GAL JOB # <br />3 = Soil/Sediment, 4 = Rinsate, 5 = Oil /06 -74641& <br />6 = Waste, 7 = Other (Specify) <br />Samplers Signature: <br />Lab Name: Green Analytical Laboratories (970) 247-4220 FAX (970) 247-4227 A yses Required <br />Address: 75 Suttle Street, Durango, CO 81303 <br /> Collection Miscellaneous Preservative(s) <br /> <br /> z_ <br />V <br /> <br />C- 0 v q <br />^ <br />1 <br />Sample ID Date Time <br />n V ? C mments <br /> V w rn V <br /> <br />o pX^3 o 00 0 O i <br /> U w Z z x z z O <br />1. G a? c (?vt.. to tot u k cR -g +Z <br />2. <br />3. '!c4 <br />4. <br />vl? <br /> <br />C7 <br /> N G <br />5. <br /> .• O <br />6. ?. <br /> <br />7. <br />8. <br />9. <br />10. <br />Relinquished by: D te- T;me: R <br />r T r <br />Relinquis ed by: Date: Time: Recei <br />ed 45y: ate: Time: <br />rk) <br />P <br />i <br />* Sample Reject: [ ] Return [ ] Dispose [ ] Store (30 Days)