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Lab Name: Green Analytical Laboratories (970) 247-4220 FAX (970)'247 -4227 <br />Analyses Required <br />?Q. (0 <br />Comments <br />Address: 75 Suttle Street, Durango, CO 81303 <br />i <br />V <br />v <br />_ <br />Sample 1D <br />Collection <br />Miscellaneous <br />Preservative(s) <br />Date <br />Time <br />Collected by: (Init.) <br />Matrix Type <br />From Table l <br />No. of Containers <br />Sample Filtered 7 Y/N <br />Unpreserved (Ice Only) <br />EONH <br />'lDII <br />tOSZH <br />HOVl1 <br />Other (Specify) <br />t. .+vtcr`z ScI(C4 <br />9 /3o /r- <br />7: <br />_tF ' <br />'2 <br />7� <br />1v <br />9e4 <br />A< itx . <br />2. itt#i . ,, <br />•! Q Yb '/ <br />.:l1 �. <br />2 <br />g <br />f l.�- <br />3 4 , 2 had w // , <br />f /3o /ii <br />ia <br />> "' <br />2 <br />2 <br />Al <br />X <br />) <br />!1./vc , . <br />4 ; ' . M 6rA r0/7 <br />P , /t'10:4 <br />TT <br />2 <br />'L <br />K <br />5. <br />6. <br />7. <br />8: <br />9. <br />10. <br />Relinquished by: <br />Date: <br />Time <br />Tunes <br />Received by <br />Received,by: <br />Date: <br />ci -30 -II <br />Date: <br />Ti <br />tit 6i <br />Time: <br />Relinquished by: <br />Date: <br />Analytical <br />Laboratories <br />Client: f C 6 <br />Contact: <br />Address: 6 ie 7 3 /' .,, �e , /Zb <br />e i s*Alge t /S Ca V3Z +mss <br />Phone Number: ?7," 7$S -4S . r <br />FAX Number:, <br />* Sample Reject: [ ] Return [ ,] Dispose [ ] Store ,(30;Days) <br />CHAIN OF CUSTODY RECORD <br />Ensure proper -- - - - - -- packaging. <br />2) 'Ship samples promptly following collection. <br />3) Designate Sample Reject Disposition. <br />PO# <br />Project Name:Al (, . eosic _ <br />64 S BIL i(A <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 (Speeifv? e' <br />Page / of <br />FOR GAL, USE ONLY <br />GAL JOB # <br />//of -/ St 3 <br />9- <br />0 <br />to <br />C) <br />as <br />CL <br />