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i <br /> The leoC re rt Group <br /> Chain of Custody Record <br /> An Environmental Services Company Analytical Services Request <br /> 325 Interlocken Parkway,Suite 205-Broomfield,Colorado 80021 (enclose with each shipping container) <br /> (303)438-0970-FAX(303)438-0971 <br /> Client: 5�z�J L•_L' �-0.44 Contact: ✓ r4V � d Addresses r/�e1 S`f C/1 e' Project Number <br /> Program/Site: `� �,^n 9/ S/G✓,( �/ Z: � Phone: S�1A e i-z�ny�.C_� 32V 39/ <br /> Collected by: These fields may be used <br /> for field test results <br /> O� <br /> Sample Date Sample 114 <br /> ON, <br /> Oc Uto- U� r=O <br /> Identification Sampled Time Type Total <br /> roa+'0cs1' <br /> Condition on Receipt/Temp: <br /> Comments: ��� n � � < .� t./�✓ >/ <br /> Relinquished by: cK —Representing: n jT-£/../.( r4,1,gl To Whom: ! i a Datefrime: 2 J <br /> Relinquished by: Representing: To Whom: Date/Time: <br /> Relinquished by: Representing: Rec. at Lab By: ��'^ �g��+ Datum:: 9.12�9y Iola <br /> WHITE COPY:Accompanies Samples CANARY COPY:Lab PINK COPY:Samp er <br />