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CHAIN -OF- CUSTODY FORM <br />CLIENT COX & jj X11 I N1101b- L L G <br />ADDRESS P.4, &x S-3S <br />5ovrt sa arj?y <br />PHONE j74' 9& ,(b&FAX 2JYJ - 9�f, s'/�� <br />PROJECT � i t< , k ,,L e <br />SAMPLER'S GNATURE <br />Enviro -Chem Analytical, Inc. <br />685 West Gunnison Avenue <br />Suite 108 <br />Grand Junction, CO 81501 <br />(970) 242 -6154 phone <br />(970) 245 -9270 fax <br />Relinguished By: Lw. <br />Date/T"une - Zoi <br />Relinguished By: % <br />Date/ Tune r7- 7-7 <br />FOR LAB USE ONLY <br />Seals Intact: YES NO <br />Special m GGoxA CanditionrYES - NO <br />Speaal Inch r <br />Accepted By: �-i- <br />Datef Time 'Z- 2:? t 3 c� <br />Accepted By:_, <br />Datef Time fi <br />Preserved may: NO <br />How <br />Adequate Sample Received;( -M NO <br />IioidnegTime Ms NO <br />Delivered By: C AND USPS FedEx <br />UPS Other <br />Sample I.D. <br />Sample <br />Datef Time <br />Sample <br />Location <br />Analysis No. of <br />g L o1 Containers <br />L � <br />7 - i.z -2o/3 <br />o 8 cr <br />v s <br />og� <br />ois3 <br />X <br />X <br />X <br />X <br />Relinguished By: Lw. <br />Date/T"une - Zoi <br />Relinguished By: % <br />Date/ Tune r7- 7-7 <br />FOR LAB USE ONLY <br />Seals Intact: YES NO <br />Special m GGoxA CanditionrYES - NO <br />Speaal Inch r <br />Accepted By: �-i- <br />Datef Time 'Z- 2:? t 3 c� <br />Accepted By:_, <br />Datef Time fi <br />Preserved may: NO <br />How <br />Adequate Sample Received;( -M NO <br />IioidnegTime Ms NO <br />Delivered By: C AND USPS FedEx <br />UPS Other <br />