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CHAIN OF CUSTODY RECORD <br />. NOTES: <br />1) Ensure proper container packaging. <br />2) Ship samples promptly following collection. <br />r CJa-I F-f h C--!z) 4-Ye -f 3-13) Designate Sample Reject Disposition. <br />Phone Number. 14 ®'-7 e{. 1---'Z- Z-7 9 PO# <br />FAX Number: ! ? ..- 7,54 Project Name: 0- troww 6 <br />Page of <br />Table 1. - Matrix Type FOR GAL USE ONLY <br />1 = Surface Water, 2 = Ground Water GAL JOB # <br />3 = Soil/Sediment, 4 = Rinsate, 5 = Oil `,? <br />6 = Waste, 7 = Other (Specify) <br />Samplers Signature: <br />Lab Name: Green Analytical Laboratories (970) 247-4220 FAX (970) 247-4227 Analyses Required <br />Address: 75 Suttle Street, Durango, CO 81303 -? <br /> Colle ction Miscell aneous Pre serv ative (s) <br /> <br /> Z <br /> <br /> <br />Sample ID <br />Date <br />Time <br />„ <br />"a T <br />Z <br />Comments <br /> <br />o <br />Y a <br />> a <br />F, a <br />o -- <br /> <br />w 4) <br />°' <br />a <br /> -°' E ° °' 2 O a O O <br /> U Gi z x x x Z O q - I <br />1. S ?. _? rte ?- 1J d V 0 (0 <br />o <br />z. dv tt! ! °??ccJ . ' M m <br /> <br />4. t <br />5. <br />6. <br />7. <br />8. <br />9. <br />10. <br />Relinquished by: Date: <br />., Time: Received by: .o Date: Time: <br /> / <br />fC <br />JG9 ,,e <br />I <br /> <br />a <br />Relinquish by: Date: Time: Received by: Date: Time: <br />* Sample Reject: [ ] Return [ ] Dispose [ ] Store (30 Days)