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CHAIN -OF- CUSTODY FORM <br />CLIENT <br />ADDRESS <br />PHONE��D <br />PROJECT <br />S R'S SIGN�TURE <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:� _ <br />Date/Time_ 7- �-y 2-o/ <br />e <br />Relinguished By:, <br />Date/Time 7- - — <br />FOR LAB USE Y <br />Seals Intact: * NO <br />Received in Good C 3ndidon : NO <br />Accepted By: - 4 -� <br />Date/Time <br />Accepted By: . <br />Date/Time -111-Y 13 /0,00 <br />How <br />Adequate Sample R ' NO <br />Special Itistrixtiomx Holding Time NO <br />Delivered By: <br />UPS <br />USPS FedEx <br />Other <br />Sample <br />Sample <br />Analysis No. of <br />Sample I.D. <br />Date/Time <br />Location <br />( L Containers <br />7.-74_2^017 <br />0900 <br />D�a <br />Cl <br />,a <br />, ; <br />.� <br />T' <br />a <br />X <br />K <br />X <br />X <br />Y <br />i <br />r <br />Relinguished By:� _ <br />Date/Time_ 7- �-y 2-o/ <br />e <br />Relinguished By:, <br />Date/Time 7- - — <br />FOR LAB USE Y <br />Seals Intact: * NO <br />Received in Good C 3ndidon : NO <br />Accepted By: - 4 -� <br />Date/Time <br />Accepted By: . <br />Date/Time -111-Y 13 /0,00 <br />How <br />Adequate Sample R ' NO <br />Special Itistrixtiomx Holding Time NO <br />Delivered By: <br />UPS <br />USPS FedEx <br />Other <br />