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Gl <br />- 40 i <br />.. 03 <br />Analytical <br />Laboratories <br />Client: G ---,. !-=/L16" -z E' Y, G L G <br />Contact 13-a n9 <br />FAX Number. ?i 70 ? 0 S q C 3 CHAIN OF CUSTODY RECORD <br />Address' 0Z t Ci <br />Phone Number 9 O 3 Y$? ffS' p- Y X 6,1? 63 <br />NOTES: <br />1) Ensure proper container packaging. <br />2) Ship samples promptly following collection. <br />3) Designate Sample Reject Disposition. <br />PO# <br />Table 1. - Matrix Type . <br />1- Surface Water, 2 = Ground Water <br />3 = Soil/Sediment, 4 = Rinsate, 5 = Oil <br />6 = Waste, 7 = Other (Specify) <br />Project Name: j?icl 1; f E <br />;e f of <br />FOR GAL USE ONLY <br />GAL JOB # <br />ION-111- <br />Lab Name: Green Analytical Laboratories (970) 247-4220 FAX (970) 241'-4227 Analyses Re quired <br />Address: 75 Suttle Street, Durango, CO 81303 <br /> Collection Miscellaneous Preservative(s) X <br /> 7z.- <br /> <br /> <br /> <br /> <br />ample M <br /> <br /> <br />ate <br /> <br /> <br />ime <br /> <br />v <br />>, <br /> <br /> <br />- <br />y C. <br />'7 <br /> <br />w <br />U <br /> <br />v <br />^ <br /> <br /> <br />omments <br /> o a. <br /> <br /> U z co z b <br />1.w??7'Ze c. ? 1/ 3la ??.'v, f 2 h ?C NG <br />2:zeze wlipfAc.17 ?< 31a TZ: if 'Z 2 a.'G I? <br />Y7 .0at1--? A r? Iz: z 5 •1,9 7- 2 )4 K !c E <br />4.a55?f/A 44 ew 91ge /! 3ldl _ :: .t1G <br />s. <br />6. <br />7. <br />8. <br />9. ? <br />10. <br />/??? <br /> <br />19?---------+ <br />Relinquished Date /t; /Q <br />Tune <br />5 <br />R <br />Da <br />Relinquished by -. _. Date Time: Received Date. I rhne : <br />Sample Reject: [ ] Return [ ] Dispose [ ] Store (30 Days) <br />!