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RECEIVED <br /> CHAIN-OF-CUSTODY RECORD AND REQUEST FOR ANALYSIS `" ' <br /> McC(�QFV���_ <br /> McCULLEY, FRICK & GILMAN, INC. &CMM,INC, <br /> 737 29th Street,Suite 202 ❑ <br /> 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 !1 FAX:(512)454-4126 FAX:(415)495-7107 <br /> PROJECT No.: — PROJ CT NAME: ! J I Q�� �f ��l - PAGE: OF: 2 <br /> SAMPLER(Signa ure): PROJECT MANAGER: IeftEZ_ DATE: S- it 41 <br /> METHOD OF SHIPMENT: CARRIER/WAYBILL NO. DESTINATION: CaCC-S Shn/ t <br /> SPECIAL INSTRUCTIONS/HAZARDS: 44f <br /> SAMPLES ANALYSIS REQUEST <br /> Preservation Containers' Methods Handling REMARKS <br /> 0 0 0 0 c (Special handling <br /> N '! r, <br /> Sample om CC> CND m io : procedures,specific <br /> Collection cc E o o N N y 0 o analytical methods, <br /> o w w w [O [O [O to 10 cd X o x z observations etc. <br /> Lab Sample W _j z x Q a a a x x w W � cn a > <br /> No. IdentificationFs <br /> ATE TIME Matrix• _ _ x o z o ° z° w w w w F m o CC W <br /> K X �€ <br /> 6 l64o X K y - 3 l< `� X 260 S C L_ <br /> A41 JK <br /> �, 3 �C - - - <br /> -S a 7 a Sc tk I k _g <br /> st> 113 ( 17 <br /> .. :>;:o;:<o;:: 04 <br /> :>:::;;:>:a ::i:�::E: :� LA RAT RYCOMMENTSICONDITIONOFSAMPLES to QC f <br /> ::::TOTAL NUMBER OF CONTAINERS oQ <br /> f <br /> g <br /> d e G/ <br /> t <br /> 3 <br /> p �1. <br /> l <br /> RELINQUISHED BY: DATE TIME <br /> RECEIVED BY.. <br /> COMPANY <br /> SIGNATURE PRINTED NAME <br /> COMPANY <br /> PRINTED NA .. <br /> SIGN :::.............. ...............:. <br /> '� GG ,fJ::.. .. <br /> rJ O <br /> LABORATORY <br /> a <br /> I � <br /> -� <br /> Matrix AO-aqueous NA-wrtaqueous SO-soil SL-sludge Ppetrolaum A-air -OTZhyr Contairtera P-plastic G-glass T-teflon B-brad0tlar <br /> DISTRIBt1fION: PINK:F1ald Ccpy YELLOW:Laboratory Copy WHITE:Rot Ongim. <br />