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RECEIVED <br /> MAN 4 7 1994 <br /> CHAIN-OF-CUSTODY RECORD AND REQUEST FOR ANALYSIS PULLEY FR <br /> McCULLEY, FRICK & GILMAN, INC. & - �• <br /> ❑ 737 29th Street,Suite 202 ❑ 524 Bank Street,Suite 207 ❑ 5818 Balcones Dr.,Suite 202 E2 ZSThird St.,Suite 400 <br /> Boulder,CO 80303 Wallace, ID 83873 Austin,TX 78731 San Francisco,CA 94103 <br /> TEL:(303)447-1823 TEL:(208)556-6811 TEL:(512)371-1667 TEL:(415)495-7110 <br /> FAX:(303)447-1836 FAX:(208)556-7271 FAX:(512)454-4126 FAX:(415)495-7107 <br /> PROJECT No.: % ��-�- P QCT AME: / PAGE: F: <br /> SAMPLER(Signature): �� `/ ;� PROJECT MANAGE . DATE: <br /> METHOD OF SHIPMENT.( R6�q CARRIER/WAYBILL NO. DESTINATION: C� <br /> SPECIAL INSTRUCTIONS/HAZARDS: IIJcsN� <br /> SAMPLES ANALYSIS REQUEST <br /> Preservation Containers' Methods Handling <br /> REMARKS <br /> 0 0 0 0 `— m (Special handling <br /> Sample 0 (D � m ¢ procedures,specific <br /> Collection ¢ E o o N N o analytical methods, <br /> Lab Sample c�n� z i � a a a a a = = w o z observations,etc.) <br /> No. Identification DATE TIME Matrix• _ _ = o zz o ° Z w www m o M 0 <br /> TOTAL NUMBER OF CONTAINERS <br /> LABORATORY COMMETSCONDCONDITION OF SAMPLES <br /> Q <br /> RELINQUISHED BY: DATE TIME RECEIVED BY <br /> IGN TU E PRINTED NAME COMPANY IGN URE PRINTED NAME COMPANY <br /> h <br /> .... <br /> .............................................:. <br /> .............::... <br /> ................... <br /> .... ....:: <br /> .:: :::.. ...::.. .. ............. ................:............ ...........G C' .. .......... ......... .... ...................................:...... ...::::. AyBORATO <br /> . . .......................................................... .. ................................... <br /> 'EEY: Matrix AO-aqueous NA-nonaqueous SO-sal SL-sludge P-paboleum A-air OT-other Containers P-plasdc G-glass T-telbn B-brass OT-other <br /> DISTRIBLTIOPINK:Haid Copy YELLOW:Laboratory Copy WHITE:Ratum to Originator <br />