Laserfiche WebLink
Lab Name: Green Analytical Laboratories (970) 247 -4220 FAX (970)247 -4227 <br />Analyses Required <br />bt" c..es_ <br />l/ <br />Comments <br />Address: 75 Suttle Street, Durango, CO 81303 www.nreenanalvtical.com <br />`��• <br />s � <br />Sample ID <br />Collection <br />Miscellaneous <br />Preservative(s) <br />Date <br />Time <br />Collected by: (Init.) <br />Nlatrix TJ pe <br />From "Table I <br />\o. of Containers <br />Sample Filtered ? YIN <br />' Unpreservcd ( Ice Only) <br />( Ot�l l <br />DH <br />bOSZ1l <br />'NAOI1 -- — <br />(,•:tpads) aotpO <br />1 60; t ii -&\\ <br />r -1l -0 2 <br />2:15 PA1 <br />j G <br />1 <br />'1. <br />N <br />y <br />'t <br />14N, T <br />2.# ► t, v rr„a i. e,�,� <br />i 2-0.-/ Z <br />2's8 <br />3 ! Th '' <br />—, <br />2 <br />2 - <br />- <br />a. <br />N <br />1J <br />x <br />X <br />X <br />1( <br />14 11 <br />t TC <br />3 aowH 9 � .c.L1 <br />Z- 11 -IZ. <br />5. <br />6 <br />7 <br />8 . <br />9. <br />10. <br />Relinquished b 7,/� <br />9 y:/ 1 /'/ <br />Bat <br />�2`! /' /Z <br />T�i�n Is�r1 <br />' <br />Received b y / ,� <br />-1-.. 4 i� l <br />Date <br />! Z —!l —lL <br />Tir <br />1,2-5 l <br />Time: <br />Relinquished by:V.J <br />Date: <br />m e: <br />Time: <br />., <br />Received by: <br />Date: <br />Analytical <br />Laboratories <br />C�cr_ C —�NerC <br />T e■rc <br />(,E173 CK. t 20 <br />Client: <br />Contact: <br />Address: <br />Phone Number: 9 7c '3 g 5 'C( Zg 6,563 <br />Email: 7 3$ -'-U 3S <br />" Sample Reject: [ ] Return [ ] Dispose [ ] Store (30 Days) <br />CHAIN OF CUSTODY RECORD <br />1) Ensure pi oper container packaging, <br />2) Ship samples promptly following collection. <br />3) Designate Sample Reject Disposition. <br />Po# <br />Project Name: K% 7` Samplcrs Signature: <br />P lecc.S� ✓✓ i U SP n G T 0.tE <br />Table 1. - Matrix Type <br />1 = Surface Water, 2 = Ground Water <br />3 = SoillSediment, 4 - Rinsate. 5 = Oil <br />6 = Waste, 7 = Other (Specify) <br />Page 1 of <br />FOR GAL USL ONLY <br />GAL JOB # <br />LZ <br />N <br />0 <br />0 <br />t) <br />