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RECEIVED <br /> ---- 149 2 3 <br /> 4 A 3 <br /> CHAIN-OF-CUSTODY RECORD AND REQUEST FOR ANALYSIS <br /> RICK <br /> McCULLEY, FRICK & GILAN, INC. &c��.I <br /> l'iNC. <br /> ❑ 737 29th Street,Suite 202 ❑ 524 Bank Street,Suite 207 ❑ 5818 Balcones Dr.,Suite 202 ❑�5 Third 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.:—C t-r— i/ PROJECT NAME: -;•— �,,/= 'l is <br /> .1 < , ) '. , .!. ;/r- ,•. PAGE: OF: <br /> SAMPLER(Signature): �';' '.: PROJECT MANAGER: /I';;' %;.:. !'C: �: DATE: <br /> METHOD OF SHIPMENT: ' `,1. ' CARRIER/WAYBILL NO. DESTINATION: — <br /> SPECIAL INSTRUCTIONS/HAZARDS: ;,I''! PC _ <br /> SAMPLES ~� ANALYSIS REQUEST <br /> Preservation Containers' Methods,- . Handling REMARKS <br /> 0 0 cli 0 0 •o w (Special handling <br /> C, o N N u, o rocedares,s ecific <br /> Sample Crp p <br /> Collection E o o (M to <br /> N tn o analytical methods, <br /> p 0 w Lu iL o o (0 CO m to x o = z observations,etc.) <br /> Lab Sample Matrix `� o o v a 0 a a a n= a= o ;� i " <br /> No. Identification DATE TIME z = _ I O _ > _ Z w Lu LU LU F- r m _ M w 1..'i I . "> <br /> • r <br /> `; <br /> t i - 'j, — "� v l <br /> VOA 011 <br /> I LABORATOnY COMMENTS/CONDI110M OF SAMPLES / n(t l ITUTAL rdtL <br /> ' '> i'•i.: I ! i'�,., -} - - .�'�f•,r. "r,J! � !'. ,/i tr lrt;, ✓i.., '�' .,.�l. <br /> RELINQUISHED BY . ECEI IVED BY <br /> SIGNATURE PRINTED NAME COiviPANY DA ATE TIME SIGNATURE R PRINTED NAME COMPANY <br /> 1 / I ABO <br /> • :•Matrix AO.aquoous NA•nonaquoous SO-soil SL•sludgo Ppotro.oum Aair 07-othor Conwmers Pplastic G-glnss T•re0on Q-br= OL-olhor <br /> �216TR1Ql1T10?': PINK:Haid Ccpy YELLOW:LaborWory Copy WHITE:A.wn,to Originator <br />