Laserfiche WebLink
CHAIN -OF- CUSTODY FORM <br />CLIENT N4aJ Zvi, N,w, LLC, <br />ADDRESS ff. 0 • 'isZ <br />So gl L13 Ll <br />PHONEi�-9z %- .S�S�' 6 FAX q�3�2q- 5 /�7 <br />PROJECT e %k G-0_dC. , -w-e <br />SAMPLER'S SIGNATURE <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 />Relinquished By: <br />Date/Time 7 - 1--w3 0 � y p <br />Relinquished <br />Date/I"ime i-_l C- 7vr13 (a(7 C) <br />Accepted By: , Itp- <br />Date/rime 7- .3- & -13 e, 2 a c� <br />Accepted By: <br />Date/Time <br />FOR LAB USF ONLY Preserved ProPer�i YES-- NO <br />t: <br />Seals Intact( YES NO <br />Received fq GoodCbnditi.: YES / NO <br />Special Instructions: <br />How _ <br />Adequate Sample Received: NO <br />Holding Time YES NO <br />Delivered - USPS FedEx <br />Other- <br />Sample I.D. <br />Sample <br />Date/Time <br />Sample <br />Location <br />Analysis =� No. of <br />z `^ Containers <br />O 0 <br />e /5- <br />o � 4) <br />Relinquished By: <br />Date/Time 7 - 1--w3 0 � y p <br />Relinquished <br />Date/I"ime i-_l C- 7vr13 (a(7 C) <br />Accepted By: , Itp- <br />Date/rime 7- .3- & -13 e, 2 a c� <br />Accepted By: <br />Date/Time <br />FOR LAB USF ONLY Preserved ProPer�i YES-- NO <br />t: <br />Seals Intact( YES NO <br />Received fq GoodCbnditi.: YES / NO <br />Special Instructions: <br />How _ <br />Adequate Sample Received: NO <br />Holding Time YES NO <br />Delivered - USPS FedEx <br />Other- <br />