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Lab Name: Green Analytical Laboratories (970) 247 -4220 FAX (970) 247 -4227 <br />Analyses Required <br />QL G °C.__ <br />4 <br />JC .,, <br />Comments <br />Address: 75 Suttle Street, Durango, CO 81303 <br />7 <br />Collection <br />Miscellaneous <br />Preservative(s) <br />Sample ID <br />Date <br />Time <br />('11ui) : q patoa)o3 <br />owl uta.] <br />od:C1, xutew <br />No. of Containers <br />Sample Filtered ? Y/N <br />(quo a31) pantosaidun <br />£ON1l' <br />13 <br />tOSc.1I <br />1LOVNI <br />Other (Specify) <br />t . v ID5"/ 7I/ <br />, ,6,1,1 <br />/ .5 <br />t1 <br />° I <br />11 / <br />V <br />1 <br />e€ /MI 42 <br />Se' <br />2. D6 / -o - (7 /i <br />5loll <br />/ <br />4r 3 6 <br />//: 3 o <br />l <br />1 <br />1 <br />) <br />3. 2 CSi 7I/ <br />,... <br />-14-",-.5— <br />. <br />t <br />1 <br />i =et ..7± <br />• a.l <br />5 .eSta -71,.. c; 7(1 <br />5 <br />a1 5" <br />. 1?: <br />`-1 <br />' t7-- <br />l/ <br />:r <br />� l <br />j <br />s 7 <br />6. <br />7. <br />8. <br />9. <br />10. s 4 <br />Retin � " <br />Date / <br />Time: <br />Received by: ' <br />Date. 1 y i! <br />Time: <br />Relja[sh d y. <br />Date: <br />Time: <br />Received by: d <br />Date: <br />Time: <br />_ 0 <br />C31 <br />0 3 <br />:t0 <br />Analytical <br />La boratorie <br />Client: r' ✓r �' . :fir / '/:J.'1. <br />Contact( .a1114 <br />Address: .c.5 / l t-- r'r�a'K�✓s "` �i'1!l'� <br />i4f ( ' ir f/ f <br />Phone Number:347.'a 9 ff � f ,„ ; li'" <br />FAX Number: `5Wf - , 7 2 74/4 <br />* Samar Rcjcct: [)Return [ J Dispose [ 7 Storc (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 />�' e r . <br />Project Name: a�; /,f d <br />H CAS- © - <br />Table 1, - Matrix Type <br />0 = Surface Water, 2 = Ground Water <br />3 = Soil/Sediment, 4 = Rinsate, 5 = Oil <br />6 = Waste, 7 = OthFt(Specify) .) <br />Samplers Signature: <br />Page t of / <br />FOR GAL USE ONLY <br />GAL JOB # <br />Page 23 of 30 <br />