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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 />Alvort Iv v 441 2 -1$ <br />?" <br />• r1 J(OE)�� <br />25y1 4 014 <br />. l ,,.c 1 45 <br />• S, =�� m �� M <br />Sample ID <br />Collection <br />Miscellaneous <br />Preservative(s) <br />av ,.nop. <br />1 <br />Date <br />Time <br />Collected by: (Init.) <br />Matrix Type <br />From Table I <br />No. of Containers <br />Sample Filtered ? YIN <br />Unpreserved (Ice Only) <br />£ONH <br />'13H <br />H2SO4 <br />NAOH <br />Other (Specify) <br />1. Q (— 1 <br />I \VI to <br />143 <br />" <br />} <br />S <br />K <br />! ` <br />x <br />' <br />l:ke•ric t. t'It.i1Lst sw" <br />2. TD Ko SEEP <br />• <br />163 a <br />? t <br />A•s Past 4i ckte� <br />3. Sti-t - ] <br />O.40 <br />t <br />0 p <br />"I.KkP <br />4. SW -2 <br />I <br />1...�%o <br />Opp <br />, <br />, <br />5. DG-2. <br />_ <br />tt30 <br />+ <br />'4' <br />' <br />Z & <br />V <br />7 <br />6. 55 -1 D - <br />44 <br />o <br />4A <br />3 <br />i <br />14c <br />X <br />7. SS - l 3 -ti. <br />8. SS - L <br />0 100 <br />og0o <br />P <br />4, <br />,; <br />9. •1OPri 1 Ittcu. <br />° 1 <br />AA <br />1- <br />1 <br />13 <br />X <br />X <br />6 l�s s \ <br />IT'DG — -2, <br />_ <br />5 12 0 /ro <br />li o <br />�l <br />f <br />5 <br />a40 46.-4 <br />. <br />. <br />J; <br />i <br />1,.,. 1:e-i.-... e <br />Relinquished by: k A <br />Date: <br />S <br />7D }tea <br />Time: <br />l3er0 <br />Received bf. <br />! -• i ..4 <br />Date: <br />- i -!6 <br />Time: <br />0 <br />Relinquished by <br />Date: <br />Time: <br />Received by: 0 P <br />Date: <br />Time: <br />G <br />f <br />0 2 <br />a 3 <br />a1 <br />4.5 <br />o7 <br />Oct <br />/0 <br />o(7 <br />Analytical <br />Laboratories <br />Client <br />Contact e.tRw ��It <br />Address: q0 3 .. t:rSz <br />C'c Kramr , r 4, ca> 9O\L -- <br />Phone Number: (:Sa3) <br />FAX Number: <br />* Sample Reject [ ] Return [ ] Dispose [ ] Store (30 Days) <br />CHAIN OF CUSTODY 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: 1 .. -4 ‘ 1 - 1 :344- - r ,•,i 1 .* <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) &cu <br />Samplers Signature: <br />Page of <br />FOR GAL USE ONLY <br />GAL JOB # <br />/05 -. /0a <br />