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Bpi <br />-GZ <br />COA <br />CHAIN OF CUSTODY RECORD <br />NOTES: <br />1) Ensure proper container packaging. Table 1. - Matrix Type <br />2) Ship samples promptly following collection. I = Surface Water, 2 = Ground Water <br />3) Designate Sample Reject Disposition. 3 = Soil/Sediment, 4 = Rinsate, 5 = Oil <br />PO# 6 = Waste, 7 = Other (Specify) <br />Project Name: L<t0C_ V e el#JCV? Samplers Signature: ^--? <br />Page of <br />rOR GAL USEONLY <br />GAL JOB # <br />Lab Name: Green Analytical Laboratories (970) 247-4220 FAX (970) 247-4227 Analyses Required <br />Address: 75 Suttle Street, Durango, CO 81303 <br /> Collection Miscellaneous Preservative(s) <br /> x <br /> ^ ? o <br /> <br />Sample ID <br />Date <br />Time <br />B;, c u <br />:? C w <br />V <br />Comments <br /> <br />u ?- <br />? <br /> F w c <br /> <br />U d <br />?t <br />z .. <br />a <br />x <br />x <br />z .e <br />0 <br />1. WA- WWI6 `y /o <br />?f6 tCiv r 9 ?o io y 2 iv ,CIN c <br />3 esswG?t,c 6/ 3e !o q7 TJS N C <br />4• A G c f' /e 3.9 <br />5. <br />6. <br />7. <br />8. <br />9. <br />10. <br />Relinquished by: /J Date: ! <br />/0 T' Received by D7 <br />-o! i6 <br />r / ?{s <br />Relinquished by: Date: Time: Received by. Date: Time: <br />* Sample Reject: [ ] Return [ ] Dispose [ ] Store (30 Days)