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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 />t Wpsve <br />! / / 1i / )/f' 11 q <br />---1- <br />-...._ <br />ca <br />I 51 ZS <br />7W /I '0,'`` 0,7( kid., <br />t. <br />,.. <br />...., <br />' <br />Sample ID <br />Collection I <br />Miscellaneous I <br />Preservative(s) <br />Date <br />Time <br />Collected by: (Init.) <br />Matrix Type <br />From Table 1 <br />No. of Containers <br />Sample Filtered ? YIN <br />Un preserve d (Ice Only) <br />EONII <br />'IOH <br />tom -1I <br />IIONN <br />Other (Specify) <br />I ' COI 02 i 5 <br />2 k <br />/f.5 PM <br />q"SC <br />A5.7 <br />f <br />, <br />0 <br />t O . <br />iti I <br />Ani <br />i <br />l <br />r <br />i <br />i <br />2 '.60,9-01c <br />3. 00;-Gat <br />7 4tit <br />5: P .5 <br />04 <br />'V' <br />iV 1 <br />1 <br />[ <br />s <br />.4. <br />i <br />6. <br />7. <br />7. <br />8. <br />9. ./.. <br />10 . 7/ <br />I <br />Relinqui <br />DateW./ <br />Tim, : / 0 <br />Time: <br />Received by: ---4 ...- <br />Received by: <br />Datm <br />Date: <br />Time: <br />Time: <br />Relinquished b: <br />Date: <br />01 <br />Ana lytica <br />Laboratories <br />k i d / <br />Client: ;://1 <br />Contact: Ciee /Lt. <br />Address: R 14/ - 55 5" PIC-100A <br />r . Wit/ <br />Phone Number: 72 -67 q 5 5 c <br />FAX Number: 303 — 15 - 5 7 <br />l * Sa eject:[ ] Return [ j Dispose [ 1 Store (30 Days) <br />CHAIN OF CUSTODY RECORD <br />NOTES: <br />1) Ensure proper container packaging. <br />2) Ship samples promptly following collection. <br />3) Designate Sample Reject Disposition. <br />PO# <br />Project Name::efrypfri- <br />• <br />Table 1. - Matrix:Type <br />Surface Water, 2= GroundWater <br />3. = Soil/Sediment. 4 =Rinsate, 5 = Oil <br />6 = Waste, 7= Othcri(Sp5offy): <br />Samplers Signature:O <br />Page of <br />FOR GAL USE ONLY <br />GAL JOB # <br />11M <br />• <br />