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:AN ENVIRONMENTAL SERVICES COMPAN <br />1341 Cannon Street • Louisville, CO 80027 <br />303.661.9324 • 303.661.9325 fax • www.seacrestgroup. <br />Chain of Custody Record <br />(enclose with each shipping container <br />-S' 9 <br />Client: P. ? r Contact: s r[; J <br />Program/Site: 4w tz Phone:I-7/ <br />Collected by: <br />Date Sample <br />Sample Identification Type <br />fE114,wnt. Rar?..inn Ce.,x..e.., a Ammr%lnri Time <br />Acute <br />o cm k <br />V 4 <br />} ?Ary7ddress: d `` <br />Chronic <br />3 s' <br />4io <br />J 1/0. <br /> <br />' -1 <br />? r I F I <br />1 11 <br />s oc)/ ?csl <br />2 <br /> <br />3 <br /> <br />4 <br /> <br />5 <br /> <br />6 <br /> <br />7 <br /> <br />8 <br /> <br />9 <br />i <br />! <br />lo <br />comments and special testing instructions: •? F9 /-7-r/- cZ h /w S <br />Relinquished by: /and r,?,?e-?// Representing: (111Pj ki-vAl-'L To Whom: ?? Date/Time: `-/U-/O <br />Relinquished by: Representing: To Whom: Date/Time: <br />Next recipient: Relinquished by: Rec'd by: Daterrime: g fCcc <br />WHITE COPY: Accompanies samples CANARY COPY: Client <br />Purchase Order Nurnoer <br />Project Number(iab use only) <br />31 ?'ZI 2- <br />S C9ti Qcti a Total Total <br />Units Volume