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r!! aCre.PtGrouY <br />ENVIRONMENTAL SERVICES COMPAN <br />1341 Cannon Street • Louisville, CO 80027 <br />303.661.9324 • 303.661.9325 fax • www.seacrestgroup. <br />Client <br />Chain of Custody Record <br />(encloses with each shipping container) <br />J <br />Contact: '-./L2 ft,rv? ?¢ r y <br />Program/Site:S(, Phone: / - 7/ 9 -?-75--7Y /1 c v 7 o q <br />Collected by: <br />I Acute <br />Sample Identification Date Sample <br />Type <br />IFM..anf oe..e:.d.... T:... <br />ro o <br />o ? k r <br />i p? ?m C <br />Address:5 <br />Chronic <br />3 <br />o <br />s <br />?rl (? <br />Purchase Order Number) <br />Project Numberpab use only) <br />.?,?C12i 43 <br />T a <br />/jezq ,a, <br /> <br /> D I's <br />0 6- <br />2 <br /> <br /> <br />3 <br /> <br />4 <br /> <br />5 <br /> <br />6 <br /> <br />7 <br /> <br />8 <br /> <br />9 <br /> <br />1101 <br />comments and special testing instructions: <br />Relinquished by: ? G- -Yw,,rwi Representing: <br />-10 - ,2 To Whom: -5e Date/Time: UZ -/G+ / } o-o <br />Relinquished by: Representing: To Whom: Date/Time: <br />Next recipient: Relinquished by: Rec'd by: Date/rime: d 9 *L O -Izoo <br />WHITE COPY: Accompanies samples CANARY COPY: Client