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r!1! aCre.PtGrouY <br />ENVIRONMENTAL SERVICES COMPAN <br />1341 Cannon Street a Louisville, CO 80027 <br />303.661.9324 a 303.661.9325 fax a www.seacrestgroup. <br />Client: <br />Program/Site: CLt 4,' Q • <br />Chain of Custody Record <br />(enclose with each shipping container) <br />Contact: 6) O ct N 1-4- A r V Address: Co 1 <br />Phone: 7/9-275'7`f43 EbZo9 ,, 0-5o2. <br />Collected by: o/. ,,? <br />Acute Chronic <br />Purchase Order Number <br />Project Numbernab t,se only) <br />2J I <br />3 i' a <br />co ? `? ? o cc ro ?; . i u y ? ? <br />Sample m a a? ?? c' o C <br />Sample Identification Date Type I c7 ~ Total Total <br />(EMuent. Receiving. Sediment. bet th.A Samr,led TimA /." <br />:C Qa <br /> -- -- <br />7 <br />5 " Units Volume <br />1 ? T'lGleN? <br />©? <br />Og0810 rv <br />?5 ,s- r?dP'yp° '? <br />:?:"Cob ` <br />k <br />X <br />1 <br />2 <br /> <br />3 <br /> <br />4 <br /> <br />5 <br /> <br />6 <br /> <br />7 <br /> <br />8 <br /> <br />9 <br /> <br />10 <br />Comments and special testing instructions: S A a L, d /.le Z <br />Relinquished by: 50.4T,v??G?-? Representing: (mot ee (tc4.,.jQ To Whom: Se ??PStGrev, Date/Time: <br />Relinquished by: <br />Next recipient: <br />Representing: <br />Relinquished by: <br />WHITE COPY: Accompanies samples <br />To Whom: <br />Rec'd by: ?' <br />CANARY COPY: Client <br />Date/Time: <br />Date/Time: ??Q8--i S-30,