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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 />1 ✓ .I ✓(��J r <br />Sample'ID <br />Collection <br />Miscellaneous <br />Preservative(s) <br />Date <br />Time <br />Collected by: (Lit.) <br />Matrix Type <br />From Table 1 <br />No. of Containers <br />Sainple Filtered ? Y/N <br />Unpreserved (Ice Only) <br />£O <br />I :10H <br />t'OSZH <br />I IONN <br />Other (Specify) <br />l.. �/' - ;- r'<",•7ii <br />/i7 //� <br />/0'.G., <br />t <br />r ?C <br />: <br />/ <br />_ I <br />t��I <br />'' <br />e",i /4F/..,,, <br />2. 1 /> 1-0 • / 71 / <br />{ Ai 7 // <br />/kg &• <br />� <br />% ! <br />4.5,�_s�ltr_ —, l <br />•-- <br />4 <br />I <br />Z <br />-,i <br />5.S — 3- (' 57 /li <br />5 <br />7.?i S <br />9L <br />7 <br />.! <br />t i <br />! <br />,y <br />Ni <br />6. <br />7. <br />&. <br />9. <br />10. <br />Relingtiish ' <br />,.. ':',ii;;,, ; __ <br />Data: <br />, ': //r; /; <br />Time: <br />Received by: i i <br />1 i .. _ . / <br />Date: <br />, — 1 7 i I <br />Timer ' <br />/ ; �j 7.5. <br />Relinquished by: " <br />Date: <br />Time: <br />Received by: <br />Date: <br />Time: <br />Analy <br />Laboratories <br />Client: <br />�� ✓lam, =T /- . `> <br />Contact/(.,, ,,,,� j /1-X -[ <br />Address: 5:551,. 1, Tc _' <br />Phonc Number: I/2 5.- .- <br />FAX Number: "50.. ; 1 /66 <br />* Sample Reject: [ ] Return [ ] Dispose [ ] Store (30 Days) <br />CHAIN OF CUSTODY RECORD <br />I) Ensure proper container Ig. <br />2) Ship samples promptly FollOwing collection. <br />3) Designate Sample Reject tion. <br />P0# <br />Project Name:,/' <br />f <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 />Samplers Signature: is <br />• <br />• <br />Page of <br />FOR GAL USE ONLY <br />GAL JOB # <br />