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Lab Name: Green Analytical Laboratories (970) 247 -4220 FAX (970) 247 -4227 <br />Analyses Required <br />Comments <br />Address: 75 Suttle Street, Durango, CO 81303 <br />7 I ,7 �! C <br />• % . / ...� <br />Collection <br />Miscellaneous , <br />Preservative(s) <br />Sample ID <br />Date <br />Time <br />Collected by: (Init.) <br />Matrix Type <br />From Table I <br />No. of Containers <br />Sample Filtered '? Y1 <br />Unpreserved (Ice Only) <br />LONI! <br />1OH <br />tOSZEI <br />1IOVN <br />Other (Specify) <br />1' 5'tti -CI- 65 iti c/ <br />V lr& <br />/7.15' 1 <br />l�W /1�.. <br />� � <br />3. <br />i <br />) <br />I <br />t <br />, 4 <br />3. '.,. /.. , <br />f <br />4 l i, <br />," .) i <br />( <br />i <br />/ <br />/ <br />/ <br />, <br />'- <br />4. <br />5. <br />6. <br />7. <br />s. <br />9. <br />10. f I <br />Relinquished .� f <br />rill / <br />Date: _• <br />Time; <br />E-1 <br />Received by: �1 .-9 <br />f_. = <br />Date: <br />t 4 <br />1 <br />Time: <br />r z <br />Relinquished b . <br />Date: <br />Time: <br />Received by: ,, <br />Date: <br />Time: <br />FAX Number: <br />Analytic. <br />Laboratories <br />Client " 12cV r :. . <br />y� <br />Contact: 1- " : 1 <br />7-4 A.?.I. <br />Address: s'7,..<1 2 7?'- <br />ma <br />Phone Number: " ,' a <br />4 ✓i_ `- <br />* San ject: [ ] Return [ ] Dispose [ ] Store (30 Days) <br />CHAIN OF Y RECORD <br />I) Ensure proper container packaging. <br />2) Ship samples promptly following collection. <br />3) Designate Sample Reject Disposition. <br />PO# <br />Project Name: j >" / Cye9i.= % ",'x,74:" .' <br />• <br />Table 1. — Matrix Type <br />0 = Surface Water, 2 = Ground Water <br />3 = Soil /Sediment, 4 = Rinsate, 5 = Oil <br />6 = Waste, 7 = Oth ( cify) <br />Samplers Signature / /r' <br />Page of <br />FOR GAL USE ONLY <br />GAL JOB # <br />11 c-07) <br />Page 21 of 26 <br />