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Lab Name: Green Analytical Laboratories (970) 247 -4220 FAX (90) 247-427 <br />Analyses Required <br />(- <br />7.2-' <br />Comments <br />Address: 75 Suttle Street, Durango, CO 81303 www.greC.nanaiytica].com <br />Sample ID <br />Collection <br />Miscellaneous Preservative(s) <br />Date <br />Time <br />HOVN <br />1OSC11 <br />TDII <br />CONE <br />(quo 331) pomosaadun <br />N/A pa.ta1i I aldtueS <br />SJODU.'jUOJ JO '0N <br />1 Olqui ulou <br />3drii X!Jfl \ <br />(•1iul) ::<q POPOIIoJ <br />Other (Specify) <br />1. <br />2. rt 1- , + ' r . + <br />' 3 <br />9` 1, Y 11 1 11111 <br />d <br />x <br />■■.■■�■■■■■■■■�1\ <br />X <br />, .. i. <br />14 .. <br />" . r <br />!ril�i�ir7 <br />� io ,� ., � <br />5. <br />6. <br />7. <br />8. <br />9. <br />10. <br />Relinquished by: / \ , <br />Date: 3 <br />Time: // , 55 4 <br />Received by: <br />Date: <br />Time: <br />Relinquished by: <br />Date: <br />Time: <br />Received by: I � <br />Date: <br />Time: <br />Relinquished by: <br />Date: <br />Time: <br />Received by: <br />Date: <br />Time: <br />oq <br />Gex L <br />'rot-, 3 r <br />073 ciq lab <br />Ifi16 g 1 3a1D <br />Phone Number: 40 3 D-r) gg' /..:i 7„S 3 PO# <br />Email: 9 70 - 3,9 _'-1 3 ' <br />Client: <br />Contact: <br />Address: <br />Analytical <br />Laboratories <br />* Sample Reject: [ ] Return [ ] Dispose [ ] Store (30 Days) <br />CHAIN OF CUSTODY RECORD <br />I) Ensure proper container packaging. <br />2) Ship --- ples promptly .. _ ing collection. <br />3) Designate Sample Reject Disposition. <br />Project Name: <br />Table 1. -- Matrix Type <br />1 — Surface Water, 2 Ground Water <br />3 — Soil /Sediment, 4 _ Prod.W., 5 = Oil <br />6 = Waste, 7 = Other (Specify) <br />Samplers Signature: <br />c-5 ecl-c,116 <br />Page / of <br />tOR GAL USL• ONLY <br />GAL JOB # <br />131 - t 7b <br />Page 12 of 13 <br />