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CHAIN USTODY RECORD rata mp umber CZ my : -- <br /> -c,>d — O 9 — 0,7 <br /> / <br /> ACZI-aboratories, <br /> R S LTS TO: BI TO: <br /> Inc. SUE •�c wJ/5g6� <br /> 30400 Downhill Drive t 5 31 NE T <br /> Steamboat Springs 'CO 80487 'prrt�p A- 8 5`Z. <br /> (303) 879.6590 (800) 334-5493 Attn: AvF— Tel: Zdlo_ —zz 53 Attn: Tel.• <br /> PROJECT or P.O. # 3L l .qto CA- cn ANALYSES REQUESTED <br /> SAMPLERS: ISignature) int Name) z x REMARKS <br /> SAMPLE IDENTIFICATIONSAMPLE o �� `, o -� <br /> DATE TIME MATRIX ,t )`• )o q <br /> 5P-V-- L0 1 3 m 04nr <br /> � z x 5! & .4�..�qe. �•0 <br /> AM <br /> Ste-- MW 3 — L001 z 4 1L k avFAu ',e�� <br /> cd <br /> A4 r�J 7-/5-/t3rn Um2 .3 lL �C <br /> EL- V1'j�l 4-- JnAIV Z 5 ,4m z 3 s� <br /> 3 E-T /'YIW S'= *A) 2)sh3 4•n <br /> /3F2'— M02e — A4AJ Z/03 41A z <br /> 3 <br /> METHOD OF SHIPMENT: FED X UPS HAND OTHER COMMENTS <br /> SAMPLE DISPOSAL OPTIONS -Please complete section A, or'choose one option from sections B AND C. -91 `x v L, = 03 <br /> Pro <br /> of charges wr71 be assessed. ��PjOb b'��SS <br /> (A)long-term storage /B a Is Non-Hazardous lCl If Sample Is Hazardous II - - <br /> Hold until (date) I Dis os 11 RCRA-Permitted Facility L (Q D• �.•_ S��o� } <br /> for future analysis. 2) RCRA-Permitted Facility Z) Return to Client <br /> 3 Return to Client SAMPLES RECEIVED IN <br /> RELIN DISHED BY: (SIGNATURE) DATE TIME RECEIVED BY: ( IGNATURI_) DATE TIME PAGE / <br /> l <br /> OF <br /> Whita -Ratfan w/aarnnla YRllnw - RP.tli►n wJsarnnIA Pink - rantiirn wlcamnfn GOLLD-kAPn fnr votir records <br />