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• ,�. • RECE/ V� <br /> CHAIN-OF-CUSTODY RECORD AND REQUEST FOR AWALY IS '"Y23 <br /> 3 <br /> . X94 <br /> McCULLEY, FRICK CILIIIIAN, INC. 6� -<<4E ft1CK <br /> ❑ 737 29th Street,Suite 202 ❑ 524 Bank Street,Suite 207 [] 5818 Balcones Dr.,Suite 202 E] 5 Third St.,Suite 400'SNC, <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.: "'`' PROJECT NAME: ./�.. ..��� PAGE: "�'. OF: ?- <br /> SAMPLER (Signature): —PROJECT MANAGER: DATE: <br /> METHOD OF SHIPMENT: CARRIER/WAYBILL NO. DESTINATION: ! <br /> SPECIAL INSTRUCTIONS/HAZARDS: <br /> SAMPLES ANALYSIS REQUEST <br /> Preservation Containers' Methods Handling <br /> w REMARKS <br /> 0 0 0 0 E (Special handling <br /> Sample _ w M co � Ca � procedures,specific <br /> Collection cr c? o o analytical methods, <br /> Lab Sample p O I7 uI w w `D w 0 `a w o observations,etc.) <br /> No. Identification DATE TIME <br /> Matrix* = _ = O0 O 0 O o w ul w u I- � F O <br /> m r o <br /> . <br /> r• — <br /> 77 <br /> _ l'-i •"-lr,, I .T�' c!�' _ 8 Irl <br /> � .t <br /> !0-i SAMPLES <br /> S 'i�,i ` II •�:� •a' 4'" t •1i, - <br /> �,�.-,,! '�..•I: _'" il, ,:��i' i 'I ,I- it-! 1 1� ,� <br /> RELINQUISHED BY DATE TIME <br /> COMPANY � <br /> RECEIVED 9Y <br /> SIGNA URE/ PRINTED NAME <br /> SIGNATURE. PRINTED NAME COMPANY <br /> R :i r.... . i.. :.. �..; <br /> it//r / /` ` /-•�/7 erGJ;� ���9r` i 1, 1 ._. ;i. ` _.' / .i.:. ! //�/i rr r <br /> i <br /> t <br /> ....... <br /> i'�///Jf. :/. l i.:: �•:� 1. 1 / '/ y l y '•1 1 � Ti <br /> LABORAT <br /> � i <br /> • Mainz AO-aquaous NA•nonaquaous SO-soil SL-sluCgo Ppowoloum Aair OT-ot1Nr Conlnincrs P-plas:b G-glass T•to/bn S-bres.^, O1.T':olbar <br /> 2STELWLQM: FINK:FioWCcpy YELLOW:Lsburctory Copy Wlil-,E:noturn to Originator <br />