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The 1eaCreft Group 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: S t 1i7 ' ro Contact: 1,214 l'C'i'/ L C Address:x/ /v�o�S ff� >J-e' Project Number <br /> Program/Site: S t 1 ✓ / Phone: 3 G j 3 6 l— .S 3-� e;11L1t :"t'o» e" 0 +y390 <br /> y These fields may be used <br /> Collected by: u for field test results <br /> o o <br /> c <br /> O G U C <br /> Sample Date Sample c, _ 0- a 2 � r <br /> Identification Sampled Time Type Q U U U rc �— Total <br /> 'L— h c, l > 2d C c a <br /> Condition on Receipt/Temp: <br /> Comments: <br /> Relinquished by: t J Representing: V v s l alf QA Id To Whom: !/ r' .S DateTme: 972'A 7 97, 77 3e5 <br /> Relinquished by: Representing: To Whom: DatwTime: <br /> Relinquished by: Representing: Rec. at Lab B . Date/Time: <br /> WHITE COPY:Accompanies Samples CANARY COPY:Lab PINK COPY ampler <br />