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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 />4 1 1 0 <br />, <br />a <br />Y /5/ IT <br />1 <br />r '07N <br />Sample ID <br />Collection <br />Miscellaneous 1 <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 />Unpreserved (Ice Only) <br />£ONI I <br />133 <br />bOSZIi <br />IIOVN <br />Other (Specify) <br />1. O©1 N 02 i5 <br />2 k i( <br />1. 1/ <br />CS <br />: 5v <br />(4, <br />b- <br />5 <br />Al <br />/fi <br />.` <br />t <br />k <br />. <br />• <br />` <br />, <br />l <br />,,. <br />„ f• 1 4 /t` /5 frh <br />2. (29- . .01 <br />;. 00 –0 <br />zl/s ;/ <br />5. t5 <br />hl'.. <br />iv <br />1 <br />1 <br />4. <br />1 <br />5. <br />J f UD °C. <br />. <br />7. <br />8. <br />9. / <br />10. <br />Relinqui /Y" `b, , i a <br />Date: <br />Tim - / p <br />Received by: <br />. , ;e <br />Date: <br />–1 -N <br />Time: <br />Relinquished by: r <br />Date: <br />Time: <br />Received by: J . / - <br />Date: <br />Time: <br />01 <br />Ana Iytica <br />Jf Laboratorie <br />%iYC <br />Client: ii7' f " <br />,Contact: `^7/o, ./ /21. <br />A4dress: 1 c-. 15 Pre-veal' <br />G ,-PP.i, e'SUr��Ccf�r . Co. C. a/ <br />Phone Number: 720 -6 q.t - :2 3 el <br />FAX Number: 303 —53' 5 �, ., 74116 <br />*• Sam eject:[ ) Return [ ) Dispose [) Store (.30 : Days) <br />' <br />CHAIN OF CUSTODY RECORD <br />1) proper container packaging. <br />2) Ship samples promptly following collectitm. <br />3) Designate Sample Reject Disposition. <br />PO# <br />Project Name: */f,yP ./- /4/4, <br />• <br />Table 1. — Matrix Type <br />. Surface Water, 2 = _Ground Water <br />3 = Soil/Sediment, 4 = Rinsate, 5 = Oil <br />6 = Waste, 7 = Other (Sp <br />t <br />Samplers Signature, <br />Page of <br />FOR GAL USG ONLY <br />GAL JOB <br />