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IIII Illillllllllllll <br />W.~.1. Ins <br />Winer do Environmental TesNnr Inc 399 {f'rs1I100 Noah. B Orem. Ulak 84057 (807)13f9741 Fax /801)135-9560 <br /> <br />Chain of Custody Record <br />I Ctutomer. ~~- -N~~lryf~ ~ ~/~/7finr~- I Sampler. ~,~/c~,~ <br />f Sample Date: /5 ~TJ,~.J~ ~ ( Projeck: <br />Sample Information <br />Sample # Dale Trme CompositirlGiab I.ocxrtion Analysis Requested ' <br /> <br />"~ `r o ~ : 3 a.~ G~ Pv~io 0 0 <br />L ,,:~~r Tyr <br />~~fL <br /> <br /> <br /> <br />Sam le Custod rd <br />r, <br /> <br />u ;P~t/.L <br />Temperature Received iu the Lab: Effluent:1~,. 0 ° ~- <br />Receiving Water. <br />coolQ: wa ~ Nana odi.eq nn~a: SY~p~ <br />Hls la W.Et ht Cove 9I/N <br />Nave ~ ~NINA <br />i .noha/la~g9 CarsessCm4~es 16Ed? ~iueY~Smyie? <br />Yte Yn ~/ Ya <br />No ~ No No <br />G1mdr Sods Uad Y / <br />fnncl Y / N <br />5~6cat Qmmsr dReoes'ies <br />w.er! <br />Ya ~_ <br />N. <br />s~ <br />COC ~~NisadY! <br />Ye <br />No <br />Qe6n Received by: Datell"~me <br />~. - <br />b- -v ~30 <br />Relinquished by: Datef!'uae <br /> <br />Relinquished by: ' ed by: Daterlime <br />Sample Received in Lab by Dabell"une <br />to-Zo- <br />